Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019-2021: A national study

Faris G Bakri; Heyam H Mukattash; Hiam Esmeiran; Glenna Schluck; Casey K Storme; Erica Broach; Tsedal Mebrahtu; Mohammad Alhawarat; Anais Valencia-Ruiz; Oussama M'Hamdi; Jennifer A Malia; Zebiba Hassen; Mah'd M S Shafei; Ala Y Alkhatib; Mahmoud Gazo; Saied A Jaradat; Yessenia Gomez; Samantha McGeehon; Melanie D McCauley; Sarah C Moreland; Janice M Darden; Mihret Amare; Trevor A Crowell; Sandhya Vasan; Nelson L Michael; Julie A Ake; Kayvon Modjarrad; Paul T Scott; Sheila A Peel; Shilpa Hakre; RV505 study group

doi:10.1016/j.ijid.2024.107079

Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019-2021: A national study

Int J Infect Dis. 2024 Aug:145:107079. doi: 10.1016/j.ijid.2024.107079. Epub 2024 Apr 30.

Authors

Faris G Bakri¹, Heyam H Mukattash², Hiam Esmeiran³, Glenna Schluck⁴, Casey K Storme⁴, Erica Broach⁴, Tsedal Mebrahtu⁴, Mohammad Alhawarat⁵, Anais Valencia-Ruiz⁶, Oussama M'Hamdi⁶, Jennifer A Malia⁷, Zebiba Hassen⁴, Mah'd M S Shafei⁸, Ala Y Alkhatib⁹, Mahmoud Gazo⁸, Saied A Jaradat¹⁰, Yessenia Gomez¹¹, Samantha McGeehon¹¹, Melanie D McCauley¹¹, Sarah C Moreland¹¹, Janice M Darden¹², Mihret Amare¹¹, Trevor A Crowell⁴, Sandhya Vasan⁴, Nelson L Michael¹³, Julie A Ake¹⁴, Kayvon Modjarrad¹⁵, Paul T Scott¹⁵, Sheila A Peel⁷, Shilpa Hakre¹⁶; RV505 study group

Affiliations

¹ Division of Infectious Diseases, Department of Internal Medicine, Jordan University Hospital, Amman, Jordan; Infectious Diseases and Vaccine Center, University of Jordan, Amman, Jordan.
² Primary Health Care Directorate, Ministry of Health, Amman, Jordan.
³ HJF Medical Research International (HJFMRI), Amman, Jordan.
⁴ Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD.
⁵ Communicable Diseases Directorate, Ministry of Health, Amman, Jordan.
⁶ Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
⁷ Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
⁸ Central Public Health Laboratory, Ministry of Health, Amman, Jordan.
⁹ Voluntary Counselling and Testing Center, Ministry of Health, Amman, Jordan.
¹⁰ Princess Haya Biotechnology Center, Jordan University of Science and Technology, Irbid, Jordan.
¹¹ Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
¹² Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD; Diagnostics and Countermeasures Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
¹³ Center for Infectious Diseases Research, Walter Reed Army Institute of Research, Silver Spring, MD.
¹⁴ United States Military HIV Research Program, Walter Reed Army Institute of Research, Silver Spring, MD.
¹⁵ Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD.
¹⁶ Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, MD; Emerging Infectious Diseases Branch, Walter Reed Army Institute of Research, Silver Spring, MD. Electronic address: [email protected].

PMID: 38697607
DOI: 10.1016/j.ijid.2024.107079

Abstract

Background: Limited epidemiologic studies have been conducted in Jordan describing the HIV epidemic. This study aimed to address this gap to inform HIV prevention and control.

Methods: A nationally-representative cross-sectional study was conducted among adults living with HIV in Jordan. Laboratory testing included HIV viral load and next-generation-sequencing-based clinical genotype. Log-binomial regression estimated risk ratios (RRs) and 95% confidence intervals (CIs).

Results: Among 231 (70%) participants, most were male (184/80%), and from Jordan (217/94%). Among 188 treatment-experienced-participants (>6 months), 165 (88%) were virally suppressed. High-level resistance was most frequent against nucleoside reverse transcriptase inhibitor (13/81%), and integrase-strand transfer inhibitor (INSTI) (10/62%) drugs among viremic (≥1000 HIV copies/mL) treatment-experienced participants with drug-resistant mutations (DRMs, n = 16). Common HIV subtypes (n = 43) were B (6/14%), A1 (5/12%), and CRF01_AE (5/12%); additionally, novel recombinant forms were detected. In multivariate analysis, independently higher risk for late diagnosis (n = 49) was observed with diagnosis through blood donation (vs check-up: RR 2.20, 95%CI 1.16-4.17) and earlier time-period of diagnosis (1986-2014 vs 2015-2021: RR 2.87, 95%CI 1.46-5.62).

Conclusions: Late diagnosis and INSTI resistance endanger national HIV prevention and treatment in Jordan-high-level resistance to INSTI suggests therapeutic drug monitoring is needed for treatment efficacy and conservation of treatment options.

Keywords: Antiretroviral resistance; HIV; Jordan; Molecular epidemiology.

MeSH terms

Adolescent
Adult
Anti-HIV Agents* / pharmacology
Anti-HIV Agents* / therapeutic use
Cross-Sectional Studies
Drug Resistance, Viral* / genetics
Female
Genotype
HIV Infections* / drug therapy
HIV Infections* / epidemiology
HIV Infections* / virology
HIV-1 / drug effects
HIV-1 / genetics
Humans
Jordan / epidemiology
Male
Middle Aged
Viral Load*
Young Adult

Substances

Anti-HIV Agents