ArticleNature communications2024
HIV transmission dynamics and population-wide drug resistance in rural South Africa.
Article in Nature communications, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 15 papers.
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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.
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Who cites it
15 citing papers in PubMed, 13 citations in OpenAlex.
- HIV-1 integrase inhibitor resistance in viraemic-treated individuals and baseline capsid diversity relevant to future lenacapavir therapy.The Journal of antimicrobial chemotherapy · 2026Article
- Dibenzoacridinium derivatives: a new class of G-quadruplex ligands with anti-HIV-1 properties.RSC medicinal chemistry · 2026Article
- Geostatistical point process modelling of HIV prevalence using disease progression and CD4 cell count dynamics.iScience · 2026Article
- Extensive diversity and impact of drug-resistant HIV-1 variants in individuals with prior virologic failure.PLoS pathogens · 2026Article
- Nationwide patterns of HIV drug resistance and high viral load in Sub-Saharan African countries.The Journal of antimicrobial chemotherapy · 2026Article
- HIV drug resistance during antiretroviral therapy scale-up in Uganda, 2012-19: a population-based, longitudinal study.The Lancet. Microbe · 2025Article
- Treatment of Advanced HIV in the Modern Era.Drugs · 2025Review
- Computational and Population-Based HLA Permissiveness to HIV Drug Resistance-Associated Mutations.Pathogens (Basel, Switzerland) · 2025Article
- Evidence from HIV sequencing for blood-borne transmission in Africa.Journal of public health in Africa · 2025Review
- Prevalence and transmission of HIV-1 drug resistance mutations among patients with treatment failure and newly diagnosed people in Liangshan Prefecture, China, in 2021-2023.Frontiers in public health · 2025Article
- Development and Evaluation of an Optimised Sanger-Based Assay for HIV-1 Drug Resistance Genotyping in Chinese Circulating Strains Across Subtypes and Viral Loads.Infection and drug resistance · 2025Article
- Preventing perinatal HIV acquisition; current gaps and future perspectives.Current opinion in HIV and AIDS · 2024Review
- Article
- Population dynamics of HIV drug resistance during treatment scale-up in Uganda: a population-based longitudinal study.medRxiv : the preprint server for health sciences · 2024Article
- Low prevalence of archived integrase strand transfer inhibitors resistance associated mutations in Botswana before the roll out of dolutegravir based first line antiretroviral therapy.Frontiers in microbiology · 2024Article
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Authors and funding
15 authors at 6 institutions in 3 countries.
Funding
Abstract
Despite expanded antiretroviral therapy (ART) in South Africa, HIV-1 transmission persists. Integrase strand transfer inhibitors (INSTI) and long-acting injectables offer potential for superior viral suppression, but pre-existing drug resistance could threaten their effectiveness. In a community-based study in rural KwaZulu-Natal, prior to widespread INSTI usage, we enroled 18,025 individuals to characterise HIV-1 drug resistance and transmission networks to inform public health strategies. HIV testing and reflex viral load quantification were performed, with deep sequencing (20% variant threshold) used to detect resistance mutations. Phylogenetic and geospatial analyses characterised transmission clusters. One-third of participants were HIV-positive, with 21.7% having detectable viral loads; 62.1% of those with detectable viral loads were ART-naïve. Resistance to older reverse transcriptase (RT)-targeting drugs was found, but INSTI resistance remained low (<1%). Non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance, particularly to rilpivirine (RPV) even in ART-naïve individuals, was concerning. Twenty percent of sequenced individuals belonged to transmission clusters, with geographic analysis highlighting higher clustering in peripheral and rural areas. Our findings suggest promise for INSTI-based strategies in this setting but underscore the need for RPV resistance screening before implementing long-acting cabotegravir (CAB) + RPV. The significant clustering emphasises the importance of geographically targeted interventions to effectively curb HIV-1 transmission.
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Registered trials
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.