Advancing HIV Drug Resistance Technologies and Strategies: Insights from South Africa's Experience and Future Directions for Resource-Limited Settings

Kim Steegen^{1

2

3}, Gert U van Zyl^{4

5}, Mathilda Claassen^{4

5}, Aabida Khan^{6

7}, Melendhran Pillay^{6

7}, Subitha Govender⁷, Phillip A Bester^{8

9}, Johanna M van Straaten⁹, Vibha Kana¹⁰, Ewaldé Cutler¹⁰, Monalisa N Kalimashe¹⁰, Ramokone L Lebelo^{11

12}, Mokopi B H Moloi^{11

12}, Lucia Hans^{1

2

3}

Affiliations

¹ Department of Molecular Medicine and Haematology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Hospital, Johannesburg 2193, South Africa.
² Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa.
³ Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa.
⁴ Division of Medical Virology, Stellenbosh University, Stellenbosh 7602, South Africa.
⁵ Division of Medical Virology, Stellenbosh National Health Laboratory Service, Tygerberg Hospital, Tygerberg 7505, South Africa.
⁶ Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa.
⁷ Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4058, South Africa.
⁸ Department of Medical Microbiology and Virology, University of the Free State, Bloemfontein 9300, South Africa.
⁹ Department of Medical Microbiology and Virology, National Health Laboratory Service, Universitas Academic Hospital, Bloemfontein 9301, South Africa.
¹⁰ Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg 2192, South Africa.
¹¹ Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa.
¹² Department of Virological Pathology, National Health Laboratory Service, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa.

PMID: 37443603
PMCID: PMC10340187
DOI: 10.3390/diagnostics13132209

Review

Advancing HIV Drug Resistance Technologies and Strategies: Insights from South Africa's Experience and Future Directions for Resource-Limited Settings

Kim Steegen et al. Diagnostics (Basel). 2023.

. 2023 Jun 29;13(13):2209.

doi: 10.3390/diagnostics13132209.

Authors

Affiliations

¹ Department of Molecular Medicine and Haematology, National Health Laboratory Service, Charlotte Maxeke Johannesburg Hospital, Johannesburg 2193, South Africa.
² Department of Molecular Medicine and Haematology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa.
³ Wits Diagnostic Innovation Hub, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg 2000, South Africa.
⁴ Division of Medical Virology, Stellenbosh University, Stellenbosh 7602, South Africa.
⁵ Division of Medical Virology, Stellenbosh National Health Laboratory Service, Tygerberg Hospital, Tygerberg 7505, South Africa.
⁶ Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4041, South Africa.
⁷ Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4058, South Africa.
⁸ Department of Medical Microbiology and Virology, University of the Free State, Bloemfontein 9300, South Africa.
⁹ Department of Medical Microbiology and Virology, National Health Laboratory Service, Universitas Academic Hospital, Bloemfontein 9301, South Africa.
¹⁰ Centre for HIV and STIs, National Institute for Communicable Diseases, Johannesburg 2192, South Africa.
¹¹ Department of Virological Pathology, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa.
¹² Department of Virological Pathology, National Health Laboratory Service, Sefako Makgatho Health Sciences University, Pretoria 0204, South Africa.

PMID: 37443603
PMCID: PMC10340187
DOI: 10.3390/diagnostics13132209

Abstract

Monitoring of HIV drug resistance (HIVDR) remains critical for ensuring countries attain and sustain the global goals for ending HIV as a public health threat by 2030. On an individual patient level, drug resistance results assist in ensuring unnecessary treatment switches are avoided and subsequent regimens are tailored on a case-by-case basis, should resistance be detected. Although there is a disparity in access to HIVDR testing in high-income countries compared to low- and middle-income countries (LMICS), more LMICs have now included HIVDR testing for individual patient management in some groups of patients. In this review, we describe different strategies for surveillance as well as where HIVDR testing can be implemented for individual patient management. In addition, we briefly review available technologies for HIVDR testing in LMICs, including Sanger sequencing, next-generation sequencing, and some point-of-care options. Finally, we describe how South Africa has implemented HIVDR testing in the public sector.

Keywords: HIV drug resistance testing; acquired drug resistance; next-generation sequencing; pretreatment drug resistance; surveillance.

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Conflict of interest statement

The authors declare no conflict of interest.

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References

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Advancing HIV Drug Resistance Technologies and Strategies: Insights from South Africa's Experience and Future Directions for Resource-Limited Settings

Affiliations

Advancing HIV Drug Resistance Technologies and Strategies: Insights from South Africa's Experience and Future Directions for Resource-Limited Settings

Authors

Affiliations

Abstract

Conflict of interest statement

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