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. 2017 Dec 19;216(12):1569-1578.
doi: 10.1093/infdis/jix544.

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

Rachel A Silverman  1   2 , Ingrid A Beck  3 , Catherine Kiptinness  2 , Molly Levine  3 , Ross Milne  3 , Christine J McGrath  2 , Steve Bii  3 , Barbra A Richardson  2   4 , Grace John-Stewart  1   2   5   6 , Bhavna Chohan  2 , Samah R Sakr  7 , James N Kiarie  8 , Lisa M Frenkel  2   3   5   6   9 , Michael H Chung  1   2   5
Affiliations

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

Rachel A Silverman et al. J Infect Dis. .

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.

Keywords: HIV; Pretreatment drug resistance; antiretroviral therapy; oligonucleotide ligation assay; transmitted drug resistance.

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Figures

Figure 1.
Figure 1.
Pretreatment HIV drug resistance (PDR) by age, gender, and antiretroviral (ARV) experience. Bar charts illustrate the prevalence of PDR and 95% confidence intervals by 5 age categories (<18, 18–24, 25–35, 35–50, and 50 years and older). Data are shown for all 987 study participants (A), 849 ARV-naive participants (B), and 138 ARV-experienced participants (C). In each panel, data are shown stratified by gender.
See this image and copyright information in PMC

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