Browsing by Author "Pillay, Selvan"

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    Resistance Testing for Management of HIV Virologic Failure in Sub-Saharan Africa
    (Annals of Internal Medicine, 2021) Siedner, Mark J.; Moosa, Mahomed-Yunus S.; McCluskey, Suzanne; Gilbert, Rebecca F.; Pillay, Selvan; Aturinda, Isaac; Ard, Kevin; Muyindike, Winnie; Musinguzi, Nicholas; Masette, Godfrey; Pillay, Melendhran; Moodley, Pravikrishnen; Brijkumar, Jaysingh; Rautenberg, Tamlyn; George, Gavin; Gandhi, Rajesh T.; Johnson, Brent A.; Sunpath, Henry; Bwana, Mwebesa B.; Marconi, Vincent C.
    Virologic failure in HIV remains a major public health threat in sub-Saharan Africa. It occurs in approximately 10% to 30% of patients within 2 years of antiretroviral therapy (ART) initiation and is associated with development of drug resistance, increased risk for opportunistic infections and death, and ongoing transmission of HIV (1–6). The optimal management of virologic failure is unknown. Guidelines published by the U.S. Department of Health and Human Services recommend genotypic resistance testing (GRT) to assist in the management of virologic failure (7). Small randomized trials and observational studies completed in the early ART era in the United States suggested that GRT has benefit in virologic control and selection of active regimens (8–11). However, GRT after failure of first-line therapy is not routinely supported by treatment guidelines by the World Health Organization and is not typically done in most sub-Saharan African countries (12).