AIDS Virus Research Laboratory, HIV/AIDS and Global Health Research Programme, University of Venda, Thohoyandou, 0950, South Africa.
Global Biomed Scientific LLC, P.O. Box 2368, Forest, VA, 24551, USA.
AIDS Res Ther. 2021 Jan 6;18(1):1. doi: 10.1186/s12981-020-00324-w.
South Africa, with one of the highest HIV prevalences in the world, introduced the universal test and treat (UTT) programme in September 2016. Barriers to sustained viral suppression may include drug resistance in the pre-treated population, non-adherence, acquired resistance; pharmacokinetics and pharmacodynamics, and concurrent use of alternative treatments.
The purpose of this review is to highlight potential challenges to achieving sustained viral load suppression in South Africa (SA), a major expectation of the UTT initiative.
Through the PRISMA approach, published articles from South Africa on transmitted drug resistance; adherence to ARV; host genetic factors in drug pharmacokinetics and pharmacodynamics, and interactions between ARV and herbal medicine were searched and reviewed.
The level of drug resistance in the pre-treated population in South Africa has increased over the years, although it is heterogeneous across and within Provinces. At least one study has documented a pre-treated population with moderate (> 5%) or high (> 15%) levels of drug resistance in eight of the nine Provinces. The concurrent use of ARV and medicinal herbal preparation is fairly common in SA, and may be impacting negatively on adherence to ARV. Only few studies have investigated the association between the genetically diverse South African population and pharmacokinetics and pharmacodynamics of ARVs.
The increasing levels of drug resistant viruses in the pre-treated population poses a threat to viral load suppression and the sustainability of first line regimens. Drug resistance surveillance systems to track the emergence of resistant viruses, study the burden of prior exposure to ARV and the parallel use of alternative medicines, with the goal of minimizing resistance development and virologic failure are proposed for all the Provinces of South Africa. Optimal management of the different drivers of drug resistance in the pre-treated population, non-adherence, and acquired drug resistance will be beneficial in ensuring sustained viral suppression in at least 90% of those on treatment, a key component of the 90-90-90 strategy.
南非是世界上艾滋病毒感染率最高的国家之一，于 2016 年 9 月推出了普遍检测和治疗（UTT）计划。持续抑制病毒可能存在的障碍包括治疗前人群中的耐药性、不遵医嘱、获得性耐药性；药物代谢动力学和药效学，以及同时使用替代治疗。
本综述旨在强调南非实现持续病毒载量抑制的潜在挑战，这是 UTT 计划的主要期望之一。
通过 PRISMA 方法，搜索并综述了南非发表的关于传播耐药性、抗逆转录病毒药物的依从性、药物代谢动力学和药效学中的宿主遗传因素以及抗逆转录病毒药物与草药之间相互作用的文章。
尽管南非各省之间存在异质性，但多年来，治疗前人群中的耐药水平有所增加。至少有一项研究记录了在九个省中的八个省中，治疗前人群的耐药水平中度（>5%）或高度（>15%）。在南非，抗逆转录病毒药物和草药制剂同时使用相当普遍，可能对药物的依从性产生负面影响。只有少数研究调查了基因多样化的南非人群与抗逆转录病毒药物的药物代谢动力学和药效学之间的关系。
治疗前人群中耐药病毒水平的增加对病毒载量的抑制和一线治疗方案的可持续性构成了威胁。建议所有南非省份都建立耐药监测系统，以跟踪耐药病毒的出现，研究先前接触抗逆转录病毒药物的负担以及同时使用替代药物的情况，以尽量减少耐药性的发展和病毒学失败。优化治疗前人群、不遵医嘱和获得性耐药性的不同驱动因素的管理，将有助于确保至少 90%接受治疗的人持续抑制病毒，这是 90-90-90 战略的关键组成部分。
