HIV-1 viraemia and drug resistance amongst female sex workers in Soweto, South Africa: A cross sectional study

Autor: Kennedy Otwombe, Lesley Scott, Johanna Ledwaba, Sephonono Molema, Jenny Coetzee, Asiashu Bongwe, Gillian Hunt, Rachel Jewkes, Glenda Gray, Maya Jaffer
Jazyk: angličtina
Rok vydání: 2017
Předmět:
0301 basic medicine
RNA viruses
Cross-sectional study
Epidemiology
Gene Identification and Analysis
lcsh:Medicine
HIV Infections
Drug resistance
Pathology and Laboratory Medicine
Geographical locations
South Africa
0302 clinical medicine
Immunodeficiency Viruses
Medicine and Health Sciences
Prevalence
Medicine
030212 general & internal medicine
lcsh:Science
Phylogeny
education.field_of_study
Multidisciplinary
Transmission (medicine)
Pharmaceutics
Microbial Mutation
virus diseases
Viral Load
Middle Aged
Resistance mutation
Medical Microbiology
HIV epidemiology
Viral Pathogens
Viruses
Reverse Transcriptase Inhibitors
Female
Pathogens
Viral load
HIV drug resistance
Research Article
Adult
Sexual transmission
Genotype
Anti-HIV Agents
Population
Microbiology
03 medical and health sciences
Drug Therapy
Microbial Control
Virology
Retroviruses
Drug Resistance
Viral
Genetics
Humans
Viremia
education
Microbial Pathogens
Mutation Detection
Pharmacology
Sex Workers
business.industry
Lentivirus
lcsh:R
Organisms
Biology and Life Sciences
HIV
CD4 Lymphocyte Count
030104 developmental biology
Cross-Sectional Studies
Africa
HIV-1
lcsh:Q
Antimicrobial Resistance
People and places
business
Viral Transmission and Infection
Demography
Zdroj: PLoS ONE, Vol 12, Iss 12, p e0188606 (2017)
PLoS ONE
ISSN: 1932-6203
Popis: Background HIV drug resistance (HIVDR) poses a threat to future antiretroviral therapy success. Monitoring HIVDR patterns is of particular importance in populations such as sex workers (SWs), where documented HIV prevalence is between 34–89%, and in countries with limited therapeutic options. Currently in South Africa, there is a dearth in evidence and no ongoing surveillance of HIVDR amongst sex work populations. This study aims to describe the prevalence of HIVDR amongst a sample of female sex workers (FSWs) from Soweto, South Africa. Methodology A cross-sectional, respondent driven sampling (RDS) recruitment methodology was used to enrol FSWs based in Soweto. Participants were tested for HIV and undertook a survey that included HIV knowledge and treatment status. Whole blood specimens were collected from HIV positive FSWs to measure for CD4 counts, viral load (VL) and perform HIVDR genotyping. Frequencies were determined for categorical variables and medians and interquartile ranges (IQR) for the continuous. Results Of the 508 enrolled participants, 55% (n = 280) were HIV positive and of median age 32 (IQR: 20–51) years. Among the HIV positive, 51.8% (132/269) were defined as virologically suppressed (VL < 400 copies/ml). Of the 119 individuals with unsuppressed viral loads who were successfully genotyped for resistance testing 37.8% (45/119) had detectable drug resistance. In this group, HIVDR mutations were found amongst 73.7% (14/19) of individuals on treatment, 27.4% (26/95) of individuals who were treatment naive, and 100% (5/5) of defaulters. One phylogenetic cluster was found amongst treatment naive FSWs. The K103N mutation was detected most commonly in 68.9% (31/45) individuals with HIVDR mutations, with 20/26 (76.9%) of treatment naive FSW with detectable resistance having this mutation. The M184V mutation was found in both FSWs on treatment (12/14, 85.7%) and those defaulting (1/5, 20.0%). Discussion More than one third (45/119) of the genotyped sample had HIVDR, with resistance to the NNRTI class being the most common. Almost half of HIV positive FSWs had unsuppressed viral loads, increasing the likelihood for onward transmission of HIV. Disturbingly, more than 1:4 treatment naive women with unsuppressed viral loads had HIVDR suggesting that possible sexual transmission of drug resistance is occurring in this high-risk population. Given the high burden of HIVDR in a population with a high background prevalence of HIV, it is imperative that routine monitoring of HIVDR be implemented. Understanding transmission dynamics of HIVDR in FSW and its impact on treatment success should be urgently elucidated.
Databáze: OpenAIRE
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