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Viruses. 2014 Oct 20;6(10):3855-72. doi: 10.3390/v6103855.

Impact of human immunodeficiency virus type-1 sequence diversity on antiretroviral therapy outcomes.

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Department of Pediatrics, Yale University School of Medicine, 333 Cedar St, New Haven, CT 06520, USA.
Departments of Pediatrics and Pharmacology, Yale University School of Medicine, Child Health Research Center, 464 Congress Ave, New Haven, CT 06520, USA.


Worldwide circulating HIV-1 genomes show extensive variation represented by different subtypes, polymorphisms and drug-resistant strains. Reports on the impact of sequence variation on antiretroviral therapy (ART) outcomes are mixed. In this review, we summarize relevant published data from both resource-rich and resource-limited countries in the last 10 years on the impact of HIV-1 sequence diversity on treatment outcomes. The prevalence of transmission of drug resistant mutations (DRMs) varies considerably, ranging from 0% to 27% worldwide. Factors such as geographic location, access and availability to ART, duration since inception of treatment programs, quality of care, risk-taking behaviors, mode of transmission, and viral subtype all dictate the prevalence in a particular geographical region. Although HIV-1 subtype may not be a good predictor of treatment outcome, review of emerging evidence supports the fact that HIV-1 genome sequence-resulting from natural polymorphisms or drug-associated mutations-matters when it comes to treatment outcomes. Therefore, continued surveillance of drug resistant variants in both treatment-naïve and treatment-experienced populations is needed to reduce the transmission of DRMs and to optimize the efficacy of the current ART armamentarium.

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