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

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.

HIV drug resistance in a community‐randomized trial of universal testing and treatment: HPTN 071 (PopART)

“…Factors potentially contributing to the rise in drug resistance in these settings include increased use of ARV drugs, poor ART adherence, limited access to viral load monitoring and drug resistance testing, unreliable drug supply chains, use of less potent ART regimens, prior ARV drug exposure and transmission of drug‐resistant virus [ 5 , 7 ]. Few studies have evaluated whether provision of UTT is associated with an increase in drug resistance [ 8 , 9 , 10 ]. Increased uptake of ART in the setting of UTT could potentially increase the prevalence of drug resistance, especially in settings with limited access to routine viral load monitoring and drug resistance testing.…”

Past and current status of adolescents living with HIV in South Africa, 2005–2017

“…There might be several reasons for a gender differential in ART initiation, including female children being less likely to be taken for health care and later ART initiation in females, compared to males [ 32 ]. Lastly, this study is among the first to estimate levels of HIVDR in ALHIV in a household survey in South Africa [ 2 , 25 ]. Continued monitoring of HIVDR in ALHIV and in the general population is needed, particularly to detect pre-treatment HIVDR [ 34 , 35 ].…”

“…Non VLS (VL ≥ 1000 copies/ml) samples were evaluated for HIVDR using Next Generation Sequencing [ 2 , 24 , 25 ]. Amplification of a 1,084 base pair PCR fragment was performed as described [ 24 ].…”

Cathelicidins and defensins antimicrobial host defense peptides in the treatment of TB and HIV: Pharmacogenomic and nanomedicine approaches towards improved therapeutic outcomes

“…Further, patients living with HIV may have an increased risk for developing drug resistant TB [ 40 , 21 ]. In a study conducted in South Africa, HIVDR was detected in 27% of virally unsuppressed individuals with a higher prevalence in those who discontinued therapy [ 46 ]. Generally, antimicrobial resistance represents an imminent global health crisis, and HIVDR threatens the effective management of HIV [ 74 ].…”