The role of drug resistance in poor viral suppression in rural South Africa: findings from a population-based study.
Adolescent
Adult
Anti-HIV Agents
/ therapeutic use
Cohort Studies
Dried Blood Spot Testing
Drug Resistance, Viral
/ genetics
Female
Genotype
HIV
/ drug effects
HIV Infections
/ drug therapy
HIV Seroprevalence
Humans
Male
Middle Aged
Mutation
Prevalence
Rural Population
South Africa
/ epidemiology
Viral Load
/ drug effects
Young Adult
ART adherence
Antiretroviral therapy (ART)
HIV drug resistance
South Africa
Surveillance, viral suppression
Virological failure
Journal
BMC infectious diseases
ISSN: 1471-2334
Titre abrégé: BMC Infect Dis
Pays: England
ID NLM: 100968551
Informations de publication
Date de publication:
26 Mar 2020
26 Mar 2020
Historique:
received:
28
10
2019
accepted:
28
02
2020
entrez:
29
3
2020
pubmed:
29
3
2020
medline:
28
5
2020
Statut:
epublish
Résumé
Understanding factors driving virological failure, including the contribution of HIV drug resistance mutations (DRM), is critical to ensuring HIV treatment remains effective. We examine the contribution of drug resistance mutations for low viral suppression in HIV-positive participants in a population-based sero-prevalence survey in rural South Africa. We conducted HIV drug resistance genotyping and ART analyte testing on dried blood spots (DBS) from HIV-positive adults participating in a 2014 survey in North West Province. Among those with virologic failure (> 5000 copies/mL), we describe frequency of DRM to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI), report association of resistance with antiretroviral therapy (ART) status, and assess resistance to first and second line therapy. Analyses are weighted to account for sampling design. Overall 170 DBS samples were assayed for viral load and ART analytes; 78.4% of men and 50.0% of women had evidence of virologic failure and were assessed for drug resistance, with successful sequencing of 76/107 samples. We found ≥1 DRM in 22% of participants; 47% were from samples with detectable analyte (efavirenz, nevirapine or lopinavir). Of those with DRM and detectable analyte, 60% showed high-level resistance and reduced predicted virologic response to ≥1 NRTI/NNRTI typically used in first and second-line regimens. DRM and predicted reduced susceptibility to first and second-line regimens were common among adults with ART exposure in a rural South African population-based sample. Results underscore the importance of ongoing virologic monitoring, regimen optimization and adherence counseling to optimize durable virologic suppression.
Sections du résumé
BACKGROUND
BACKGROUND
Understanding factors driving virological failure, including the contribution of HIV drug resistance mutations (DRM), is critical to ensuring HIV treatment remains effective. We examine the contribution of drug resistance mutations for low viral suppression in HIV-positive participants in a population-based sero-prevalence survey in rural South Africa.
METHODS
METHODS
We conducted HIV drug resistance genotyping and ART analyte testing on dried blood spots (DBS) from HIV-positive adults participating in a 2014 survey in North West Province. Among those with virologic failure (> 5000 copies/mL), we describe frequency of DRM to protease inhibitors (PI), nucleoside reverse transcriptase inhibitors (NRTI), and non-nucleoside reverse transcriptase inhibitors (NNRTI), report association of resistance with antiretroviral therapy (ART) status, and assess resistance to first and second line therapy. Analyses are weighted to account for sampling design.
RESULTS
RESULTS
Overall 170 DBS samples were assayed for viral load and ART analytes; 78.4% of men and 50.0% of women had evidence of virologic failure and were assessed for drug resistance, with successful sequencing of 76/107 samples. We found ≥1 DRM in 22% of participants; 47% were from samples with detectable analyte (efavirenz, nevirapine or lopinavir). Of those with DRM and detectable analyte, 60% showed high-level resistance and reduced predicted virologic response to ≥1 NRTI/NNRTI typically used in first and second-line regimens.
CONCLUSIONS
CONCLUSIONS
DRM and predicted reduced susceptibility to first and second-line regimens were common among adults with ART exposure in a rural South African population-based sample. Results underscore the importance of ongoing virologic monitoring, regimen optimization and adherence counseling to optimize durable virologic suppression.
Identifiants
pubmed: 32216752
doi: 10.1186/s12879-020-4933-z
pii: 10.1186/s12879-020-4933-z
pmc: PMC7099808
doi:
Substances chimiques
Anti-HIV Agents
0
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
248Subventions
Organisme : NIAID NIH HHS
ID : P30 AI027763
Pays : United States
Organisme : NIMH NIH HHS
ID : P30 MH062246
Pays : United States
Organisme : US Centers for Disease Control and Prevention
ID : 5U2GGH000324-02
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