Prevalence of HIV-1 Drug Resistance among Women Screening for HIV Prevention Trials in KwaZulu-Natal, South Africa MTN-009Reportar como inadecuado




Prevalence of HIV-1 Drug Resistance among Women Screening for HIV Prevention Trials in KwaZulu-Natal, South Africa MTN-009 - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Background

A major concern with using antiretroviral ARV-based products for HIV prevention is the potential spread of drug resistance, particularly from individuals who are HIV-infected but unaware of their status. Limited data exist on the prevalence of HIV infection or drug resistance among potential users of ARV-based prevention products.

Methods

A cross-sectional study of reproductive-aged women who presented to screen for an HIV prevention trial was conducted at 7 clinical sites in Durban, South Africa. CD4+T cell counts, HIV-1 RNA levels and population sequencing of the protease and reverse transcriptase genes were performed for all women with 2 positive HIV rapid tests. Resistance mutations were identified using the Stanford Calibrated Population Resistance Tool.

Results

Of the 1073 evaluable women, 40037% were confirmed as HIV-infected. Of those, plasma HIV-1 RNA was detectable in 365-40091% and undetectable<40 copies-ml in 35-4009% women. 156 women39% were eligible for antiretroviral therapy CD4+T cell counts<350 cells-mm3 and 5013% met criteria for AIDSCD4<200 cells-mm3. Of 352 plasma samples>200 copies-ml analyzed for drug resistance, 267.4% had nucleoside reverse transcriptase inhibitor NRTI, non-nucleoside reverse transcriptase inhibitor NNRTI or protease inhibitor PI drug resistance mutations. Among those with resistance, 18-26 participants62% had single-class NNRTI resistance and 5-2619% had dual-class NRTI-NNRTI. Major mutations in reverse transcriptase included K65Rn = 1, L74In = 1, K103Nn = 19, V106Mn = 4, Y181Cn = 2, M184Vn = 4, and K219E-Rn = 2. Major PI-resistance mutations were rare: M46Ln = 1 and I85Vn = 1. All participants were infected with subtype C virus, except one infected with subtype A.

Conclusions

In women from Durban, South Africa screening for an HIV prevention trial, the HIV prevalence was high 37% and HIV drug resistance prevalence was above 5%. This study highlights the potential challenges faced when implementing an ARV-based prevention product that overlaps with first-line antiretroviral therapy. Effective screening to exclude HIV infection among women interested in uptake of ARV-based HIV prevention will be essential in limiting the spread of ARV resistance.



Autor: Urvi M. Parikh , Photini Kiepiela, Shayhana Ganesh, Kailazarid Gomez, Stephanie Horn, Krista Eskay, Cliff Kelly, Barbara Mensch,

Fuente: http://plos.srce.hr/



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