Evidence map›Paper›PMID 34223118›Full record

ArticleJAC-antimicrobial resistance2021

High level of HIV drug resistance informs dolutegravir roll-out and optimized NRTI backbone strategy in Mozambique.

V Carnimeo, I A Pulido Tarquino, S Fuentes, D Vaz, L Molfino, N Tamayo Antabak, R M Cuco, A Couto, S Lobo, J de Amaral Fidelis and 4 more

Open access · goldAbstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in JAC-antimicrobial resistance, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 6 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
6citing papers in PubMed, 1 pooled it
0.8field-weighted citation impact, top 24% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

6 citing papers in PubMed, 1 synthesis or guideline pooled it, 13 citations in OpenAlex.

  1. Pooled it
  2. Article
  3. Article
  4. Article
  5. Article
  6. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 6 institutions in 4 countries.

V CarnimeoEpicentre, Paris, France.ORCID https://orcid.org/0000-0001-5450-1255
I A Pulido TarquinoMédecins Sans Frontières Belgium, Mozambique Mission.
S FuentesEpicentre, Paris, France.
D VazMédecins Sans Frontières Switzerland, Mozambique Mission.
L MolfinoMédecins Sans Frontières Switzerland, Mozambique Mission.
N Tamayo AntabakMédecins Sans Frontières Switzerland, Mozambique Mission.
R M CucoNational Directorate of Public Health, Ministry of Health, Maputo, Mozambique.
A CoutoMinistry of Health of Mozambique, Maputo, Mozambique.
S LoboHealth Directorate of Maputo, Maputo, Mozambique.
J de Amaral FidelisProvincial Health directorate, Tete, Mozambique.
J S MulassuaProvincial Health directorate, Tete, Mozambique.
I CigleneckiMédecins Sans Frontières, Geneva, Switzerland.
T EllmanMédecins Sans Frontières, Southern Africa Medical Unit (SAMU), South Africa.
B SchrammEpicentre, Paris, France.
Médecins Sans Frontières · CHInstituto Superior Politecnico de Tete · MZMédecins Sans Frontières · BEMinistry of Health · MZMédecins Sans Frontières · ZANational Directorate of Geology · MZ

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundHIV drug resistance (HIV-DR) is rising in sub-Saharan Africa in both ART-naive and ART-experienced patients.

objectivesTo estimate the level of acquired DR (ADR) and pre-treatment DR (PDR) across selected urban and rural sites in Southern Africa, in Mozambique.

methodsWe 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).

resultsAmong 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.

conclusionsIn 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.

Identifiers

PMID34223118
PMCPMC8209982
OpenAlexW3162702982

What OpenQuestion holds

Textmetadata
LicenceCC BY-NC
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.