HIV-1 protease inhibitor drug resistance in Kenyan antiretroviral treatment-naive and -experienced injection drug users and non-drug users

Abstract

BackgroundAlthough injection drug use drives antiretroviral drug resistance, the prevalence of protease inhibitor (PI) resistance among Kenyan IDUs remains undetermined. We, therefore, explored PI resistance mutations and their association with viral load and CD4+ T cell counts in HIV-1 infected IDUs (ART-naive, n = 32; and -experienced, n = 47) and non-drug users (ART-naive, n = 21; and -experienced, n = 32) naive for PI treatment from coastal Kenya.ResultsOnly IDUs harboured major PI resistance mutations consisting of L90M, M46I and D30 N among 3 (6.4 %) ART-experienced and 1 (3.1 %) -naive individuals. Minor PI mutations including A71T, G48E, G48R, I13V, K20I, K20R, L10I, L10V, L33F, L63P, T74S, V11I, and V32L were detected among the ART-experienced (36.2 vs. 46.9 %) and -naive (43.8 vs. 66.7 %) IDUs and non-drug users, respectively. All the four IDUs possessing major mutations had high viral load while three presented with CD4+ T cell counts of <500 cells/ml. Among the ART-naive non-drug users, CD4+ T cell counts were significantly lower in carriers of minor mutations compared to non-carriers (P < 0.05).ConclusionTransmitted drug resistance may occur in IDUs underscoring the need for genotyping resistance before initiating PI treatment.

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

“…We found a similar PDR prevalence (9%-13%) across urban and rural sites, which was contrary to our expectation that PDR 1) 20 (0) 14 (118-24 39 7) 32 (7) 7 (025 -35 247 (30) 169 (24) 78 635-50 386 (27) 218 (18) 168 950+ 143 (13) 80 6 prevalence would be lower at the rural than the urban clinics. Whereas some previous studies have generally found lower PDR in rural settings [39][40][41][42][43][44][45][46][47][48][49], our more recent results may reflect improved access to ART in the rural regions. Our observed 12% PDR prevalence among 212 adult participants (11% among ARV-naive) at the rural Maseno clinic was slightly higher than the 9% TDR prevalence observed in another recently published study of 87 ARV-naive participants conducted in 2012, also based in Western Kenya [50], providing further evidence of PDR in this rural setting.…”

Prevalence of human immunodeficiency virus-1 drug-resistant mutations among adults on first- and second-line antiretroviral therapy in a resource-limited health facility in Busia County, Kenya

“…Past studies in Kenya have identified mutations conferring resistance to specific classes of ARVs [ 9 - 11 ]. At the coastal region of Kenya, L90M, M46I and D30N mutations conferring resistance to PIs were identified among out-patients injecting drug users [ 9 ].…”

“…Past studies in Kenya have identified mutations conferring resistance to specific classes of ARVs [ 9 - 11 ]. At the coastal region of Kenya, L90M, M46I and D30N mutations conferring resistance to PIs were identified among out-patients injecting drug users [ 9 ]. A study on HIV-1 drug-resistance patterns in Nairobi identified M184V, K65R, T215Y and K70R mutations conferring resistance to NRTIs and K103N, G190A, V106A, Y184V, A98G, Y181C mutations conferring resistance to NNRTIs [ 10 ].…”

Anemia Burden, Types and Associated Risk Factors among Kenyan Human Immunodeficiency Virus-1 and Mycobacterium Tuberculosis Co-infected Injection Substance UsersAnemia Burden, Types and Associated Risk Factors among Kenyan Human Immunodeficiency Virus-1 a

“…In Kenya, over 50,000 ISUs have been identified, and the number is on the increase predominantly in coastal, urban sites, peri-urban areas and cities ( 6 ). The prevalence of HIV infection in Kenyan ISUs is ∼18.3% with higher incidence of 18.7% mainly at the coast linked to high rates of injection substance use ( 7 ). Previous studies have reported TB to be the common co-infection in Kenyan HIV infected ISUs ( 8 ).…”