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

Abstract

ObjectivesWe assessed the prevalence and risk factors associated with virological failure among female sex workers living with HIV on antiretroviral therapy (ART) in Kampala, Uganda.MethodsWe conducted a cross-sectional study between January 2015 and December 2016 using routinely collected data at a research clinic providing services to women at high risk of STIs including HIV. Plasma samples were tested for viral load from HIV-seropositive women aged ≥18 years who had been on ART for at least 6 months and had received adherence counselling. Samples from women with virological failure (≥1000 copies/mL) were tested for HIV drug resistance by population-based sequencing. We used logistic regression to identify factors associated with virological failure.ResultsOf 584 women, 432 (74%) with a mean age of 32 (SD 6.5) were assessed, and 38 (9%) were found to have virological failure. HIV resistance testing was available for 78% (28/38), of whom 82.1% (23/28) had at least one major drug resistance mutation (DRM), most frequently M184V (70%, 16/23) and K103N (65%, 15/23). In multivariable analysis, virological failure was associated with participant age 18–24 (adjusted OR (aOR)=5.3, 95% CI 1.6 to 17.9), self-reported ART non-adherence (aOR=2.6, 95% CI 1.2 to 5.8) and baseline CD4+ T-cell count ≤350 cells/mm3 (aOR=3.1, 95% CI 1.4 to 7.0).ConclusionsA relatively low prevalence of virological failure but high rate of DRM was found in this population at high risk of transmission. Younger age, self-reported ART non-adherence and low CD4+ T-cell count on ART initiation were associated with increased risk of virological failure.

Phylogenetic and Demographic Characterization of Directed HIV-1 Transmission Using Deep Sequences from High-Risk and General Population Cohorts/Groups in Uganda

“…The MRC/UVRI and LSHTM Uganda Research Unit (MRC) conducted several population-based cross-sectional surveys in HIV-1 high-risk and general population groups in central and southwestern Uganda [29,[32][33][34][35][36]. In this analysis, we combined data collected from several populations surveyed between August 2014 and August 2017.…”

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

“…Drug-resistant HIV can also emerge during ART, especially with suboptimal adherence, leading to treatment failure and limiting treatment options [ 17 , 18 ]. 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 ].…”

“…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 ].…”