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. 2020 Nov 4;15(11):e0241071.
doi: 10.1371/journal.pone.0241071. eCollection 2020.

HIV drug resistance profile in South Africa: Findings and implications from the 2017 national HIV household survey

Sizulu Moyo  1   2 , Gillian Hunt  3 , Khangelani Zuma  1 , Mpumi Zungu  1 , Edmore Marinda  1   4 , Musawenkosi Mabaso  1 , Vibha Kana  3 , Monalisa Kalimashe  3 , Johanna Ledwaba  3 , Inbarani Naidoo  1 , Sinovuyo Takatshana  1 , Tebogo Matjokotja  1 , Cheryl Dietrich  5 , Elliot Raizes  6 , Karidia Diallo  5 , Gurpreet Kindra  5 , Linnetie Mugore  5 , Thomas Rehle  2
Affiliations

HIV drug resistance profile in South Africa: Findings and implications from the 2017 national HIV household survey

Sizulu Moyo et al. PLoS One. .

Abstract

Background: HIV drug resistance (HIVDR) testing was included in the 2017 South African national HIV household survey. We describe the prevalence of HIVDR by drug class, age, sex and antiretroviral drugs (ARV) status.

Methods: Dried blood were spots tested for HIV, with Viral load (VL), exposure to ARVs and HIVDR testing among those HIV positive. HIVDR testing was conducted on samples with VL ≥1000 copies/ml using Next Generation Sequencing. Weighted percentages of HIVDR are reported.

Results: 697/1,105 (63%) of HIV positive samples were sequenced. HIVDR was detected in samples from 200 respondents (27.4% (95% confidence interval (CI) 22.8-32.6)). Among these 130 (18.9% (95% CI 14.8-23.8)), had resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) only, 63 (7.8% (95% CI 5.6-10.9)) resistance to NNRTIs and nucleoside reverse transcriptase inhibitors, and 3 (0.5% (95% CI 0.1-2.1)) resistance to protease inhibitors. Sixty-five (55.7% (95% CI 42.6-67.9) of ARV-positive samples had HIVDR compared to 112 (22.8% (95% CI 17.7-28.7)), in ARV-negative samples. HIVDR was found in 75.6% (95% CI 59.2-87.3), n = 27, samples from respondents who reported ARV use but tested ARV-negative, and in 15.3% (95% CI 6.3-32.8), n = 7, respondents who reported no ARV use and tested ARV-negative. There were no significant age and sex differences in HIVDR.

Conclusion: 27% of virally unsuppressed respondents had HIVDR, increasing to 75% among those who had discontinued ARV. Our findings support strengthening first-line ARV regimens by including drugs with a higher resistance barrier and treatment adherence strategies, and close monitoring of HIVDR.

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Conflict of interest statement

The authors have declared that no competing interests exist

Figures

Fig 1
Fig 1. Samples tested for HIV drug resistance, South Africa, 2017.
DRT- Drug Resistant Testing; DRMs- Drug Resistant Mutations.
Fig 2
Fig 2. HIV drug resistance among virally unsuppressed survey respondents, South Africa, 2017.
NNRTI- non-nucleoside reverse transcriptase inhibitors; NRTI- nucleoside reverse transcriptase inhibitors; PI-Protease inhibitors. Bars represent the 95% Confidence interval.
See this image and copyright information in PMC

References

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    1. UNAIDS—Global HIV & AIDS statistics—2018 fact sheet. https://www.unaids.org/en/resources/fact-sheet

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