Evaluation of the management of pretreatment HIV drug resistance by oligonucleotide ligation assay: a randomised controlled trial

Publication date: Available online 7 December 2019Source: The Lancet HIVAuthor(s): Michael H Chung, Christine J McGrath, Ingrid A Beck, Molly Levine, Ross S Milne, Isaac So, Nina Andersen, Sandra Dross, Robert W Coombs, Bhavna Chohan, Nelly Yatich, Catherine Kiptinness, Samah R Sakr, James N Kiarie, Lisa M FrenkelSummaryBackgroundAlthough experts have recommended testing for pretreatment drug resistance (PDR) before antiretroviral therapy (ART) initiation, there is little evidence to support its implementation. We aimed to establish whether an inexpensive point mutation assay can improve virological suppression by identifying PDR to guide drug selection for ART in a lower-middle income country.MethodsInvestigators did an open-label, randomised controlled trial at three HIV treatment sites in Kenya: two in Nairobi and one in rural Maseno. Individuals (aged ≥2 years) were eligible to participate if they were confirmed HIV-seropositive, qualified for first-line ART, planned to reside in the area for more than 1 year, and provided informed consent. We randomly assigned participants (1:1) to either PDR testing by oligonucleotide ligation assay (OLA) to guide selection of ART or to standard of care, which did not include OLA testing. The OLA-guided therapy group had pre-ART peripheral blood mononuclear cells evaluated for drug resistance to non-nucleoside reverse transcriptase inhibitor (NNRTI) at codons Lys103Asn, Tyr181Cys, Gly190Ala, and to lamivudine at Met184Val, and when at...
Source: The Lancet HIV - Category: Infectious Diseases Source Type: research