HIV-1 viraemia and drug resistance amongst female sex workers in Soweto, South Africa: A cross sectional study

Abstract

BackgroundHIV drug resistance (HIVDR) poses a threat to future antiretroviral therapy success. Monitoring HIVDR patterns is of particular importance in populations such as sex workers (SWs), where documented HIV prevalence is between 34–89%, and in countries with limited therapeutic options. Currently in South Africa, there is a dearth in evidence and no ongoing surveillance of HIVDR amongst sex work populations. This study aims to describe the prevalence of HIVDR amongst a sample of female sex workers (FSWs) from Soweto, South Africa.MethodologyA cross-sectional, respondent driven sampling (RDS) recruitment methodology was used to enrol FSWs based in Soweto. Participants were tested for HIV and undertook a survey that included HIV knowledge and treatment status. Whole blood specimens were collected from HIV positive FSWs to measure for CD4 counts, viral load (VL) and perform HIVDR genotyping. Frequencies were determined for categorical variables and medians and interquartile ranges (IQR) for the continuous.ResultsOf the 508 enrolled participants, 55% (n = 280) were HIV positive and of median age 32 (IQR: 20–51) years. Among the HIV positive, 51.8% (132/269) were defined as virologically suppressed (VL < 400 copies/ml). Of the 119 individuals with unsuppressed viral loads who were successfully genotyped for resistance testing 37.8% (45/119) had detectable drug resistance. In this group, HIVDR mutations were found amongst 73.7% (14/19) of individuals on treatment, 27.4% (26/95) of individuals who were treatment naïve, and 100% (5/5) of defaulters. One phylogenetic cluster was found amongst treatment naïve FSWs. The K103N mutation was detected most commonly in 68.9% (31/45) individuals with HIVDR mutations, with 20/26 (76.9%) of treatment naïve FSW with detectable resistance having this mutation. The M184V mutation was found in both FSWs on treatment (12/14, 85.7%) and those defaulting (1/5, 20.0%).DiscussionMore than one third (45/119) of the genotyped sample had HIVDR, with resistance to the NNRTI class being the most common. Almost half of HIV positive FSWs had unsuppressed viral loads, increasing the likelihood for onward transmission of HIV. Disturbingly, more than 1:4 treatment naïve women with unsuppressed viral loads had HIVDR suggesting that possible sexual transmission of drug resistance is occurring in this high-risk population. Given the high burden of HIVDR in a population with a high background prevalence of HIV, it is imperative that routine monitoring of HIVDR be implemented. Understanding transmission dynamics of HIVDR in FSW and its impact on treatment success should be urgently elucidated.

Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross-sectional study

“…In South Africa, 73.7% of FSWs and in Rwanda 77.1% of FSWs with virological failure had at least one major drug resistance mutation (DRM) to either nucleoside reverse transcriptase inhibitors (NRTIs) or non-nucleoside reverse transcriptase inhibitors (NNRTIs). The lamivudine (3TC, an NRTI drug) mutation M184V and the efavirenz (EFV) and nevirapine (NVP) (two NNRTI drugs) mutations K103N and 181C are frequently observed in cases of virological failure 11 12. Yet combinations of tenofovir (TDF) 3TC and EFV/NVP are extensively used as a first-line regimen in limited resource settings 13.…”

Antiretroviral drug use and HIV drug resistance in female sex workers in Tanzania and the Dominican Republic

“…Drug-resistant HIV can also be transmitted to others [ 18 , 19 ]. To date, relatively few studies have evaluated ART failure and HIV drug resistance among FSW [ 11 , 12 , 19 , 20 ]. Many FSW are not virally suppressed, despite high levels of self-reported ART adherence [ 12 , 19 , 20 ], and a high prevalence of drug resistance has been observed in HIV-positive FSW regardless of their treatment status [ 19 , 20 ].…”

“…To date, relatively few studies have evaluated ART failure and HIV drug resistance among FSW [ 11 , 12 , 19 , 20 ]. Many FSW are not virally suppressed, despite high levels of self-reported ART adherence [ 12 , 19 , 20 ], and a high prevalence of drug resistance has been observed in HIV-positive FSW regardless of their treatment status [ 19 , 20 ]. Data on ARV drug use among FSW are also limited and have been based primarily on self-report [ 19 , 20 ], which may be unreliable [ 21 – 25 ].…”

“…Many FSW are not virally suppressed, despite high levels of self-reported ART adherence [ 12 , 19 , 20 ], and a high prevalence of drug resistance has been observed in HIV-positive FSW regardless of their treatment status [ 19 , 20 ]. Data on ARV drug use among FSW are also limited and have been based primarily on self-report [ 19 , 20 ], which may be unreliable [ 21 – 25 ]. Participants in research studies may over-report ARV drug use for a variety of reasons (e.g., because they misunderstand questionnaires or prefer to give socially-desirable answers) [ 25 , 26 ].…”

Pangea-Hiv 2

“…In recent years, most phylogenetic studies of HIV sequences sampled in sub-Saharan Africa have focussed on drug resistance mutations and their transmission [1][2][3][4], or classification of subtypes and evolutionary questions of HIV diversity [5][6][7][8]. However, sequence data is increasingly being used to construct transmission networks to inform prevention efforts [9], and to inform epidemiological studies [10 & ,11 & ].…”