{"doi":"10.1093/jacamr/dlab050","title":"High level of HIV drug resistance informs dolutegravir roll-out and optimized NRTI backbone strategy in Mozambique","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>HIV drug resistance (HIV-DR) is rising in sub-Saharan Africa in both ART-naive and ART-experienced patients.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives</jats:title>\n                  <jats:p>To estimate the level of acquired DR (ADR) and pre-treatment DR (PDR) across selected urban and rural sites in Southern Africa, in Mozambique.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>We conducted two cross-sectional surveys among adult HIV patients (October 2017–18) assessing ADR and PDR. In the (ADR) survey, those on NNRTI-based first-line ART for ≥6 months were recruited (three sites). In the PDR survey, those ART-naive or experienced with ≥3 months of treatment interruption prior were enrolled (eight sites).</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>Among 1113 ADR survey participants 83% were receiving tenofovir (TDF)/lamivudine (3TC)/efavirenz (EFV). The median time on ART was 4.5 years (Maputo) and 3.2 years (Tete), 8.3% (95% CI 6.2%-10.6%, Maputo) and 15.5% (Tete) had a VL ≥ 1000 copies/mL, among whom 66% and 76.4% had NNRTI+NRTI resistance, and 52.8% and 66.7% had 3TC+TDF-DR. Among those on TDF regimens, 31.1% (Maputo) and 42.2% (Tete) were still TDF susceptible, whereas 24.4% and 11.5% had TDF+zidovudine (ZDV)-DR. Among those on ZDV regimens, 25% and 54.5% had TDF+ZDV-DR. The PDR survey included 735 participants: NNRTI-PDR was 16.8% (12.0–22.6) (Maputo) and 31.2% (26.2–36.6) (Tete), with a higher proportion (≥50%) among those previously on ART affected by PDR.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>In Mozambique, viral failure was driven by NNRTI and NRTI resistance, with NRTI DR affecting backbone options. NNRTI-PDR levels surpassed the WHO 10% ‘alert’ threshold. Replacing NNRTI first-line drugs is urgent, as is frequent viral load monitoring and resistance surveillance. Changing NRTI backbones when switching to second-line regimens may need reconsideration.</jats:p>\n               </jats:sec>","journal":"JAC-Antimicrobial Resistance","year":2021,"id":647575,"datarank":0.6749798606423032,"base_score":2.639057329615259,"endowment":2.639057329615259,"self_citation_contribution":0.3958585994422889,"citation_network_contribution":0.2791212612000143,"self_endowment_contribution":0.3958585994422889,"citer_contribution":0.2791212612000143,"corpus_percentile":null,"corpus_rank":null,"citation_count":13,"citer_count":7,"citers_with_citation_signal":6,"citers_with_endowment":6,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":null,"is_data_producer":false,"deposit_databanks":null,"is_oa":false,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":null,"fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":1687262,"name":"I A Pulido Tarquino","orcid":null,"position":1,"is_corresponding":false},{"id":1687263,"name":"S Fuentes","orcid":null,"position":2,"is_corresponding":false},{"id":1687264,"name":"D Vaz","orcid":null,"position":3,"is_corresponding":false},{"id":1687265,"name":"L Molfino","orcid":null,"position":4,"is_corresponding":false},{"id":1687266,"name":"N Tamayo Antabak","orcid":null,"position":5,"is_corresponding":false},{"id":1687267,"name":"R M Cuco","orcid":null,"position":6,"is_corresponding":false},{"id":1687268,"name":"A Couto","orcid":null,"position":7,"is_corresponding":false},{"id":1687269,"name":"S Lobo","orcid":null,"position":8,"is_corresponding":false},{"id":1687270,"name":"J de Amaral Fidelis","orcid":null,"position":9,"is_corresponding":false},{"id":1687271,"name":"J S Mulassua","orcid":null,"position":10,"is_corresponding":false},{"id":1687272,"name":"I Ciglenecki","orcid":null,"position":11,"is_corresponding":false},{"id":1687273,"name":"T Ellman","orcid":null,"position":12,"is_corresponding":false},{"id":1687274,"name":"B Schramm","orcid":null,"position":13,"is_corresponding":false},{"id":1687261,"name":"V Carnimeo","orcid":"0000-0001-5450-1255","position":0,"is_corresponding":false}],"reference_count":0,"raw_metadata":{"has_enrichment":true,"resolved":true,"title":"High level of HIV drug resistance informs dolutegravir roll-out and optimized NRTI backbone strategy in Mozambique","abstract":"<jats:title>Abstract</jats:title>\n               <jats:sec>\n                  <jats:title>Background</jats:title>\n                  <jats:p>HIV drug resistance (HIV-DR) is rising in sub-Saharan Africa in both ART-naive and ART-experienced patients.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Objectives</jats:title>\n                  <jats:p>To estimate the level of acquired DR (ADR) and pre-treatment DR (PDR) across selected urban and rural sites in Southern Africa, in Mozambique.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Methods</jats:title>\n                  <jats:p>We conducted two cross-sectional surveys among adult HIV patients (October 2017–18) assessing ADR and PDR. In the (ADR) survey, those on NNRTI-based first-line ART for ≥6 months were recruited (three sites). In the PDR survey, those ART-naive or experienced with ≥3 months of treatment interruption prior were enrolled (eight sites).</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Results</jats:title>\n                  <jats:p>Among 1113 ADR survey participants 83% were receiving tenofovir (TDF)/lamivudine (3TC)/efavirenz (EFV). The median time on ART was 4.5 years (Maputo) and 3.2 years (Tete), 8.3% (95% CI 6.2%-10.6%, Maputo) and 15.5% (Tete) had a VL ≥ 1000 copies/mL, among whom 66% and 76.4% had NNRTI+NRTI resistance, and 52.8% and 66.7% had 3TC+TDF-DR. Among those on TDF regimens, 31.1% (Maputo) and 42.2% (Tete) were still TDF susceptible, whereas 24.4% and 11.5% had TDF+zidovudine (ZDV)-DR. Among those on ZDV regimens, 25% and 54.5% had TDF+ZDV-DR. The PDR survey included 735 participants: NNRTI-PDR was 16.8% (12.0–22.6) (Maputo) and 31.2% (26.2–36.6) (Tete), with a higher proportion (≥50%) among those previously on ART affected by PDR.</jats:p>\n               </jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions</jats:title>\n                  <jats:p>In Mozambique, viral failure was driven by NNRTI and NRTI resistance, with NRTI DR affecting backbone options. NNRTI-PDR levels surpassed the WHO 10% ‘alert’ threshold. Replacing NNRTI first-line drugs is urgent, as is frequent viral load monitoring and resistance surveillance. Changing NRTI backbones when switching to second-line regimens may need reconsideration.</jats:p>\n               </jats:sec>","is_dataset_classified":null,"base_score":2.639057329615259,"endowment":2.639057329615259,"datacite_reuse_total":0,"file_count":0,"downloads":0,"views":0,"has_version_chain":false,"is_dataset":false,"is_oa":false,"pmid":"34223118","pmcid":"PMC8209982","openalex_id":"https://openalex.org/W3162702982","authors":[],"funders":[{"funder_name":"Fundação para a Ciência e a Tecnologia, I.P.","grant_id":"PTDC/CCI-BIO/29266/2017","title":"Deep Drug Discovery and Deployment"},{"funder_name":"Médecins Sans Frontières","grant_id":"","title":null}],"total_grants":2,"fwci":0.805,"citation_percentile":0.75095735,"influential_citations":0,"citation_trend":[{"year":2021,"count":1},{"year":2022,"count":2},{"year":2023,"count":1},{"year":2024,"count":9}],"oa_status":"gold","license":"cc-by-nc","oa_locations":[{"url":"https://academic.oup.com/jacamr/article-pdf/3/2/dlab050/38269086/dlab050.pdf","host_type":"journal"},{"url":"https://academic.oup.com/jacamr/article-pdf/3/2/dlab050/38269086/dlab050.pdf","host_type":"publisher"},{"url":"http://academic.oup.com/jacamr/article-pdf/3/2/dlab050/38269086/dlab050.pdf","host_type":"publisher"},{"url":"https://doi.org/10.1093/jacamr/dlab050","host_type":"journal"},{"url":"https://pubmed.ncbi.nlm.nih.gov/34223118","host_type":"repository"},{"url":"https://www.ncbi.nlm.nih.gov/pmc/articles/8209982","host_type":"repository"},{"url":"https://europepmc.org/articles/PMC8209982","host_type":"Europe_PMC"},{"url":"https://europepmc.org/articles/PMC8209982?pdf=render","host_type":"Europe_PMC"},{"url":"http://dx.doi.org/10.1093/jacamr/dlab050","host_type":""},{"url":"https://dx.doi.org/10.1093/jacamr/dlab050","host_type":""}],"fields_of_study":["HIV/AIDS drug development and treatment","HIV/AIDS Research and Interventions","HIV Research and Treatment","03 medical and health sciences","0302 clinical medicine"],"mesh_terms":[],"keywords":["Dolutegravir","Human immunodeficiency virus (HIV)","Drug resistance","Antiretroviral drug","Drug","Virology","HIV drug resistance","Antiretroviral therapy","Medicine","Pharmacology","Viral load","Biology","Microbiology","Original Article"],"sdg_mappings":[{"sdg_number":3,"sdg_label":"3. Good health"},{"sdg_number":0,"sdg_label":"Good health and well-being"}],"linked_datasets":[],"clinical_trials":[],"software_tools":[],"database_accessions":[],"source":"live","citation_network_status":"fetched"},"created_at":"2026-08-10T01:19:16.631940Z","pmid":null,"pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}