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J Int AIDS Soc. 2014 Jul 4;17:18944. doi: 10.7448/IAS.17.1.18944. eCollection 2014.

Do HIV-1 non-B subtypes differentially impact resistance mutations and clinical disease progression in treated populations? Evidence from a systematic review.

Author information

1
Division of Clinical Epidemiology & Infectious Diseases, McGill University Health Centre, Montreal, Canada.
2
Division of Infectious Diseases, Department of Medicine, Queen's University, Kingston, Canada.
3
Lady Davis Institute, Jewish General Hospital, McGill University, Montreal, Canada.
4
Chronic Viral Illness Service, Division of Infectious Diseases & Clinical Epidemiology, Department of Medicine, McGill University and McGill University Health Centre, Montreal, Canada.
5
Division of Clinical Epidemiology & Infectious Diseases, McGill University Health Centre, Montreal, Canada; Department of Medicine, McGill University, Montreal, Canada; nitika.pai@mcgill.ca.

Abstract

There are 31 million adults living with HIV-1 non-B subtypes globally, and about 10 million are on antiretroviral therapy (ART). Global evidence to guide clinical practice on ART response in HIV-1 non-B subtypes remains limited. We systematically searched 11 databases for the period 1996 to 2013 for evidence. Outcomes documented included time to development of AIDS and/or death, resistance mutations, opportunistic infections, and changes in CD4 cell counts and viral load. A lack of consistent reporting of all clinical end points precluded a meta-analysis. In sum, genetic diversity that precipitated differences in disease progression in ART-naïve populations was minimized in ART-experienced populations, although variability in resistance mutations persisted across non-B subtypes. To improve the quality of patient care in global settings, recording HIV genotypes at baseline and at virologic failure with targeted non-B subtype-based point-of-care resistance assays and timely phasing out of resistance-inducing ART regimens is recommended.

KEYWORDS:

HIV-1; differential impact; disease progression; evidence; non-B subtypes; resistance mutation; systematic review

PMID:
24998532
PMCID:
PMC4083185
[Indexed for MEDLINE]
Free PMC Article

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