ReviewAIDS research and therapy2021
Potential challenges to sustained viral load suppression in the HIV treatment programme in South Africa: a narrative overview.
Review in AIDS research and therapy, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 14 papers.
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Who cites it
14 citing papers in PubMed.
- The association between HIV stigma and HIV incidence in the context of universal testing and treatment: analysis of data from the HPTN 071 (PopART) trial in Zambia and South Africa.Journal of the International AIDS Society · 2022Trial
- Perceptions and experiences of men on antiretroviral treatment lost to follow-up in Govan Mbeki, Mpumalanga.Southern African journal of HIV medicine · 2026Article
- Determinants of HIV viral load suppression rates in Amhara region, Ethiopia with a large number of internally displaced people.Journal of migration and health · 2025Article
- The Association Between HIV-Related Stigma and the Uptake of HIV Testing and ART Among Older Adults in Rural South Africa: Findings from the HAALSI Cohort Study.AIDS and behavior · 2024Article
- Incidence of low-level viremia and its impact on virologic failure among people living with HIV who started an integrase strand transfer inhibitors: a longitudinal cohort study.BMC infectious diseases · 2024Article
- Viral load suppression among HIV-positive adult patients on the first-line antiretroviral treatment regimen in health facilities in the City of Ekurhuleni, Gauteng province, South Africa.The Pan African medical journal · 2024Article
- Immunologic, virologic and drug resistance outcomes in an HIV-infected prospective cohort on treatment in South Africa.PloS one · 2024Observational
- Risk factors for unsuppressed viral load after intensive adherence counseling among HIV infected persons in Kampala, Uganda: a nested case-control study.AIDS research and therapy · 2023Article
- The Hepatoprotective Effects ofPlants (Basel, Switzerland) · 2023Review
- The impact of HIV on non-adherence for tamoxifen among women with breast cancer in South Africa.Breast cancer research and treatment · 2023Article
- Observational
- HIV-1C in-House RNA-Based Genotyping Assay for Detection of Drug Resistance Mutations in Samples with Low-Level Viral Loads.Infection and drug resistance · 2022Article
- Insights from Zimbabwe's SARS-CoV-2 genomic surveillance.The Lancet. Global health · 2021Article
- Undisclosed exposure to antiretrovirals prior to treatment initiation: An exploratory analysis.Southern African journal of HIV medicine · 2021Article
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Authors and funding
3 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSouth 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.
objectiveThe 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. METHODOLOGY: 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.
resultsThe 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.
conclusionThe 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.
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