Acquired HIV drug resistance among adults living with HIV receiving first-line antiretroviral therapy in Rwanda: A cross-sectional nationally representative survey

Details

• Alternative Title:
  Antivir Ther
• Personal Author:
  Musengimana, Gentille ; Tuyishime, Elysee ; Kiromera, Athanase ; Malamba, Samuel S. ; Mulindabigwi, Augustin ; Habimana, Madjid R. ; Baribwira, Cyprien ; Ribakare, Muhayimpundu ; Habimana, Savio D. ; DeVos, Josh ; Mwesigwa, Richard C. N. ; Kayirangwa, Eugenie ; Semuhore, Jules M. ; Rwibasira, Gallican N. ; Suthar, Amitabh B. ; Remera, Eric
• Description:
  Background:
  
  We assessed the prevalence of acquired HIV drug resistance (HIVDR) and associated factors among patients receiving first-line antiretroviral therapy (ART) in Rwanda.
  
  Methods:
  
  This cross-sectional study included 702 patients receiving first-line ART for at least 6 months with last viral load (VL) results ≥1000 copies/mL. Blood plasma samples were subjected to VL testing; specimens with unsuppressed VL were genotyped to identify HIVDR-associated mutations. Data were analysed using STATA/SE.
  
  Results:
  
  Median time on ART was 86.4 months (interquartile range [IQR], 44.8–130.2 months), and median CD4 count at ART initiation was 311 cells/mm3 (IQR, 197–484 cells/mm3). Of 414 (68.2%) samples with unsuppressed VL, 378 (88.3%) were genotyped. HIVDR included 347 (90.4%) non-nucleoside reverse transcriptase inhibitor- (NNRTI), 291 (75.5%) nucleoside reverse transcriptase inhibitor- (NRTI) and 13 (3.5%) protease inhibitor (PI) resistance-associated mutations. The most common HIVDR mutations were K65R (22.7%), M184V (15.4%) and D67N (9.8%) for NRTIs and K103N (34.4%) and Y181C/I/V/YC (7%) for NNRTIs. Independent predictors of acquired HIVDR included current ART regimen of zidovudine + lamivudine + nevirapine (adjusted odds ratio [aOR], 3.333 [95% confidence interval (CI): 1.022–10.870]; p = 0.046) for NRTI resistance and current ART regimen of tenofovir + emtricitabine + nevirapine (aOR, 0.148 [95% CI: 0.028–0.779]; p = 0.025), zidovudine + lamivudine + efavirenz (aOR, 0.105 [95% CI: 0.016–0.693]; p = 0.020) and zidovudine + lamivudine + nevirapine (aOR, 0.259 [95% CI: 0.084–0.793]; p = 0.019) for NNRTI resistance. History of ever switching ART regimen was associated with NRTI resistance (aOR, 2.53 [95% CI: 1.198–5.356]; p = 0.016) and NNRTI resistance (aOR, 3.23 [95% CI: 1.435–7.278], p = 0.005).
  
  Conclusion:
  
  The prevalence of acquired HIV drug resistance (HIVDR) was high among patient failing to re-suppress VL and was associated with current ART regimen and ever switching ART regimen. The findings of this study support the current WHO guidelines recommending that patients on an NNRTI-based regimen should be switched based on a single viral load test and suggests that national HIV VL monitoring of patients receiving ART has prevented long-term treatment failure that would result in the accumulation of TAMs and potential loss of efficacy of all NRTI used in second-line ART as the backbone in combination with either dolutegravir or boosted PIs.
  
  
• Subjects:
  Adult Anti-HIV Agents Anti-Retroviral Agents Cross-Sectional Studies Drug Resistance, Viral HIV-1 HIV Infections Humans Lamivudine Nevirapine Reverse Transcriptase Inhibitors Rwanda Viral Load Zidovudine

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• Keywords:
  Acquired Drug Resistance First-line ART HIV Unsuppressed Viral Load
• Source:
  Antivir Ther. 27(3):13596535221102690
• Pubmed ID:
  35593031
• Pubmed Central ID:
  PMC9263597
• Document Type:
  Journal Article
• Funding:
  001/WHO_/World Health OrganizationInternational/ ; CC999999/ImCDC/Intramural CDC HHSUnited States/
• Volume:
  27
• Issue:
  3
• Collection(s):
  CDC Public Access
• Main Document Checksum:
  urn:sha-512:cee978386b1ef12af045c73244d313ba36f2af8640c222ae126ac6f69f024622d47dde5a571f9c28d855507edf2db7f09d22fb3b1bfbadf53b57b70623837485
• Download URL:
  https://stacks.cdc.gov/view/cdc/119362/cdc_119362_DS1.pdf
• File Type:
  [PDF - 868.01 KB ]