High Levels of Acquired HIV Drug Resistance Following Virological Nonsuppression in HIV-Infected Women from a High-Risk Cohort in Uganda
| Autor: | Stella E Nabirye, Pontiano Kaleebu, Faridah Nassolo, Daniel Lule Bugembe, Nicholas Bbosa, Farouk Segujja, Jonah Omooja, Janet Seeley, Deogratius Ssemwanga, Maria Nanyonjo, Rebecca N Nsubuga, William Ssenyonga, David P. Kateete, Yunia Mayanja, Sandra Lunkuse |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Genotype Anti-HIV Agents Immunology HIV Infections Drug resistance chemistry.chemical_compound Virology Internal medicine Drug Resistance Viral Humans Medicine Uganda Treatment Failure business.industry virus diseases Viral Load Resistance mutation Confidence interval Reverse transcriptase Infectious Diseases chemistry Mutation Dolutegravir Cohort HIV-1 Female business Viral load HIV drug resistance |
| Zdroj: | AIDS Research and Human Retroviruses. 36:782-791 |
| ISSN: | 1931-8405 0889-2229 |
| DOI: | 10.1089/aid.2019.0279 |
| Popis: | HIV drug resistance (HIVDR) is of increasing health concern, especially among key populations. We investigated the prevalence of virological suppression (VS), prevalence and correlates of HIVDR in HIV-infected women, enrolled in a high-risk cohort. We enrolled 267 women initiated on first-line antiretroviral therapy (ART) between 2015 and 2018. Participants' plasma samples were analyzed for HIV RNA viral load (VL) and genotypic resistance testing was performed on those with VL nonsuppression (defined as VL ≥1,000 copies/mL). We used the Stanford HIVDR database-algorithm to assess HIVDR mutations and logistic regression to assess risk factors for VL nonsuppression and HIVDR. We observed an overall VS prevalence of 76.0% (203/267) and detected respective acquired drug resistance prevalence to non-nucleoside reverse transcriptase inhibitors (NNRTIs) and nucleoside reverse transcriptase inhibitors (NRTIs) of 81.3% [confidence interval (CI) 67.4-91.1] and 45.8% (CI 31.4-60.8) among the 48 successfully genotyped VL nonsuppressors. NNRTI mutations were observed in 81.3% (39/48) of the genotyped participants and 45.8% (22/48) had both NRTI and NNRTI mutations. The mutation K103N was detected in 62.5% (30/48) of participants, 41.7% (20/48) had M184V/I, 14.6% had K65R, and 12.5% (6/48) had thymidine analog mutations (TAMs). None of the analyzed potential risk factors, including age and duration on ART, was significantly correlated with VL nonsuppression or HIVDR. Although high levels of NNRTI mutations support the transition to dolutegravir, the presence of NRTI mutations, especially TAMs, may compromise dolutegravir-based regimens or other second-line ART options. The moderate VS prevalence and high HIVDR prevalence therefore call for timely ART switching and intensive adherence counseling. |
| Databáze: | OpenAIRE |
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