Prevalence of Pre-antiretroviral-Treatment Drug Resistance by Gender, Age, and Other Factors in HIV-Infected Individuals Initiating Therapy in Kenya, 2013-2014

J Infect Dis. 2017 Dec 19;216(12):1569-1578. doi: 10.1093/infdis/jix544.

Abstract

Background: Pre-antiretroviral-treatment drug resistance (PDR) is a predictor of human immunodeficiency virus (HIV) treatment failure. We determined PDR prevalence and correlates in a Kenyan cohort.

Methods: We conducted a cross-sectional analysis of antiretroviral (ARV) treatment-eligible HIV-infected participants. PDR was defined as ≥2% mutant frequency in a participant's HIV quasispecies at pol codons K103N, Y181C, G190A, M184 V, or K65R by oligonucleotide ligation assay and Illumina sequencing. PDR prevalence was calculated by demographics and codon, stratifying by prior ARV experience. Poisson regression was used to estimate prevalence ratios.

Results: PDR prevalences (95% confidence interval [CI]) in 815 ARV-naive adults, 136 ARV-experienced adults, and 36 predominantly ARV-naive children were 9.4% (7.5%-11.7%), 12.5% (7.5%-19.3%), and 2.8% (0.1%-14.5%), respectively. Median mutant frequency within an individual's HIV quasispecies was 67%. PDR prevalence in ARV-naive women 18-24 years old was 21.9% (9.3%-40.0%). Only age in females associated with PDR: A 5-year age decrease was associated with adjusted PDR prevalence ratio 1.20 (95% CI, 1.06-1.36; P = .004).

Conclusions: The high PDR prevalence may warrant resistance testing and/or alternative ARVs in high HIV prevalence settings, with attention to young women, likely to have recent infection and higher rates of resistance.

Clinical trials registration: NCT01898754.

Keywords: HIV; Pretreatment drug resistance; antiretroviral therapy; oligonucleotide ligation assay; transmitted drug resistance.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Adolescent
  • Adult
  • Age Factors
  • Aged
  • Cross-Sectional Studies
  • Drug Resistance, Viral*
  • Female
  • Genotype
  • Genotyping Techniques
  • HIV / drug effects*
  • HIV / genetics
  • HIV Infections / epidemiology
  • HIV Infections / virology*
  • Humans
  • Kenya / epidemiology
  • Male
  • Middle Aged
  • Mutation, Missense
  • Nucleic Acid Hybridization
  • Prevalence
  • Sequence Analysis, DNA
  • Sex Factors
  • Young Adult
  • pol Gene Products, Human Immunodeficiency Virus / genetics

Substances

  • pol Gene Products, Human Immunodeficiency Virus

Associated data

  • ClinicalTrials.gov/NCT01898754