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

• Published in: The Journal of infectious diseases Vol. 216; no. 12; pp. 1569 - 1578
• Main Authors: Silverman, Rachel A., Beck, Ingrid A., Kiptinness, Catherine, Levine, Molly, Milne, Ross, McGrath, Christine J., Bii, Steve, Richardson, Barbra A., John-Stewart, Grace, Chohan, Bhavna, Sakr, Samah R., Kiarie, James N., Frenkel, Lisa M., Chung, Michael H.
• Format: Journal Article
• Language: English
• Published: US Oxford University Press 19.12.2017
• Subjects: HIV/AIDS; Major and Brief Reports; HIV; transmitted drug resistance; oligonucleotide ligation assay; antiretroviral therapy; Pretreatment drug resistance
• ISSN: 0022-1899; 1537-6613
• DOI: 10.1093/infdis/jix544

HIV-infected participants initiating first-line antiretroviral therapy in Kenya were tested for pretreatment drug resistance (PDR) using an oligonucleotide ligation assay. PDR was detected in 9.6% (95% CI, 7.9%–11.6%), including 19.5% (95% CI, 8.8%–34.9%) of all 18–24-year-old women. 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.