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Randomized Controlled Trial
. 2019 Oct 10;14(10):e0223829.
doi: 10.1371/journal.pone.0223829. eCollection 2019.

HIV drug resistance in persons who inject drugs enrolled in an HIV prevention trial in Indonesia, Ukraine, and Vietnam: HPTN 074

Philip J Palumbo  1 , Yinfeng Zhang  1 , Jessica M Fogel  1 , Xu Guo  2 , William Clarke  1 , Autumn Breaud  1 , Paul Richardson  1 , Estelle Piwowar-Manning  1 , Stephen Hart  3 , Erica L Hamilton  4 , Ngo T K Hoa  5 , Mariya Liulchuk  6 , Latifah Anandari  7 , Tran Viet Ha  8 , Kostyantyn Dumchev  9 , Zubairi Djoerban  10 , Irving Hoffman  11 , Brett Hanscom  2 , William C Miller  12 , Susan H Eshleman  1
Affiliations
Randomized Controlled Trial

HIV drug resistance in persons who inject drugs enrolled in an HIV prevention trial in Indonesia, Ukraine, and Vietnam: HPTN 074

Philip J Palumbo et al. PLoS One. .

Abstract

Background: Persons who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We evaluated HIV drug resistance in PWID in a randomized clinical trial (HPTN 074). The study intervention included ART at any CD4 cell count with enhanced support for ART and substance use treatment.

Methods: HPTN 074 enrolled HIV-infected PWID (index participants) with viral loads ≥1,000 copies/mL and their HIV-uninfected injection-network partners in Indonesia, Ukraine, and Vietnam; the study limited enrollment of people who reported being on ART. HIV drug resistance testing and antiretroviral (ARV) drug testing were performed using samples collected from index participants at study enrollment.

Results: Fifty-four (12.0%) of 449 participants had HIV drug resistance; 29 (53.7%) of the 54 participants had multi-class resistance. Prevalence of resistance varied by study site and was associated with self-report of prior or current ART, detection of ARV drugs, and a history of incarceration. Resistance was detected in 10 (5.6%) of 177 newly diagnosed participants. Participants with resistance at enrollment were less likely to be virally suppressed after 52 weeks of follow-up, independent of study arm.

Conclusions: In HPTN 074, many of the enrolled index participants had HIV drug resistance and more than half of those had multi-class resistance. Some newly-diagnosed participants had resistance, suggesting that they may have been infected with drug-resistant HIV strains. Behavioral and geographic factors were associated with baseline resistance. Baseline resistance was associated with reduced viral suppression during study follow-up. These findings indicate the need for enhanced HIV care in this high-risk population to achieve sustained viral suppression on ART.

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Conflict of interest statement

We have read the journal's policy. None of the authors has a financial or personal relationship with other people or organizations that could inappropriately influence (bias) their work. Dr. Eshleman has collaborated on research studies with investigators from Abbott Diagnostics; Abbott Diagnostics provided reagents for some of those studies. Dr. Eshleman did not receive any funding or other support from Abbott Diagnostics. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Overview of HIV drug resistance and antiretroviral drug testing.
The figure shows a summary of the analysis of samples from HIV-infected participants enrolled in HIV Prevention Trials Network 074. HIV drug resistance detected refers to the detection of one or more major resistance mutations. Abbreviations: N, number; VL, viral load; mL, milliliter; ARV, antiretroviral.
Fig 2
Fig 2. Prevalence of HIV drug resistance and antiretroviral drug use.
The figure shows a summary of study findings. Results are presented by study site and overall (Total). The graph shows the proportion of participants with HIV drug resistance (dark bars) and the proportion of participants who had antiretroviral drugs detected (light bars). Abbreviation: ARV, antiretroviral.
See this image and copyright information in PMC

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