1. High Levels of Pretreatment HIV-1 Drug Resistance Mutations Among South African Women Who Acquired HIV During a Prospective Study
- Author
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Ivana, Beesham, Urvi M, Parikh, John W, Mellors, Dvora L, Joseph Davey, Renee, Heffron, Thesla, Palanee-Phillips, Shannon L, Bosman, Mags, Beksinska, Jennifer, Smit, Khatija, Ahmed, Heeran, Makkan, Pearl, Selepe, Cheryl, Louw, Philip, Kotze, G Justus, Hofmeyr, Mandisa, Singata-Madliki, Helen, Rees, Jared M, Baeten, and Carole, Wallis
- Subjects
Adult ,Genotype ,Anti-HIV Agents ,Clinical Trials and Supportive Activities ,pretreatment resistance ,Clinical Sciences ,Drug Resistance ,HIV Infections ,South Africa ,Young Adult ,Clinical Research ,Virology ,Drug Resistance, Viral ,HIV Seropositivity ,Genetics ,Humans ,Pharmacology (medical) ,Prospective Studies ,Viral ,Evaluation of treatments and therapeutic interventions ,Good Health and Well Being ,Infectious Diseases ,5.1 Pharmaceuticals ,6.1 Pharmaceuticals ,Mutation ,HIV-1 ,Public Health and Health Services ,Reverse Transcriptase Inhibitors ,HIV/AIDS ,antiretroviral resistance ,Female ,Antimicrobial Resistance ,women ,Development of treatments and therapeutic interventions ,Infection - Abstract
BackgroundPretreatment HIV drug resistance (PDR) undermines individual treatment success and threatens the achievement of UNAIDS 95-95-95 targets. In many African countries, limited data are available on PDR as detection of recent HIV infection is uncommon and access to resistance testing is limited. We describe the prevalence of PDR among South African women with recent HIV infection from the Evidence for Contraceptive Options and HIV Outcomes (ECHO) Trial.MethodsHIV-uninfected, sexually active women, aged 18-35 years, and seeking contraception were enrolled in the ECHO Trial at sites in South Africa, from 2015 to 2018. HIV testing was done at trial entry and repeated quarterly. We tested stored plasma samples collected at HIV diagnosis from women who seroconverted during follow-up and had a viral load >1000 copies/mL for antiretroviral resistant mutations using a validated laboratory-developed population genotyping assay, which sequences the full protease and reverse transcriptase regions. Mutation profiles were determined using the Stanford Drug Resistance Database.ResultsWe sequenced 275 samples. The median age was 23 years, and majority (98.9%, n = 272) were infected with HIV-1 subtype C. The prevalence of surveillance drug resistance mutations (SDRMs) was 13.5% (n = 37). Nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations were found in 12.4% of women (n = 34). Few women had NRTI (1.8%, n = 5) and protease inhibitor (1.1%, n = 3) mutations. Five women had multiple NRTI and NNRTI SDRMs.ConclusionsThe high levels of PDR, particularly to NNRTIs, strongly support the recent change to the South African national HIV treatment guidelines to transition to a first-line drug regimen that excludes NNRTIs.
- Published
- 2022