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About the Authors:
Zou Xiaobai
Affiliation: Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
Chen Xi
* E-mail: [email protected]
Affiliation: Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
Hongping Tian
Affiliation: Yale-China Association, New Haven, Connecticut, United States of America
Ann B. Williams
Affiliation: UCLA School of Nursing, Los Angeles, California, United States of America
Honghong Wang
Affiliation: Central South University, Hunan Province, China
Jianmei He
Affiliation: Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
Jun Zhen
Affiliation: Hunan Provincial Center for Disease Control and Prevention, Changsha, Hunan Province, China
Jennifer Chiarella
Affiliation: Yale School of Medicine, New Haven, Connecticut, United States of America
Lisebeth A. Blake
Affiliation: 454 Life Science, Branford, Connecticut, United States of America
Gregory Turenchalk
Affiliation: 454 Life Science, Branford, Connecticut, United States of America
Michael J. Kozal
Affiliation: Yale School of Medicine, New Haven, Connecticut, United States of America
Introduction
Hunan is the 11th largest province of China, situated in the southeast region of the country. Commercial sex work and injection drug use are highly prevalent; and the HIV/AIDS epidemic has expanded rapidly. Through the end of 2012 more than 16,000 HIV-infected cases have been reported in Hunan Province [1]–[4]; Hunan HIV epidemiology and treatment database system. More than 6,600 HIV-infected patients are in care and have received free antiretroviral therapy (ART) which is supported by the government. Currently, 5,133 patients remain on ART (Hunan HIV epidemiology and treatment database system). Prior to 2012 in Hunan Province, the first line ART consisted of triple therapy with 2 nucleos(t)ide reverse transcriptase inhibitors (NRTIs) with a non-nucleoside reverse transcriptase inhibitor (NNRTI) - available first line agents were: stavudine (d4T), lamivudine (3TC), zidovudine (AZT), tenofovir (TDF) and nevirapine (NVP). Boosted protease inhibitors (PI/r) have been used infrequently in Hunan. Lopinavir/ritonavir (LPV/r) could be used in second line regimens; however, there has not been wide scale use of this agent in Hunan Province as of yet. Routine HIV viral load (VL) testing is generally performed once a year in patients on ART.
Although ART is very successful in treatment HIV/AIDS, the efficacy of first line regimens can be reduced by the presence of transmitted drug resistance mutations (TDRs). There are few data...