Moderate to high levels of pre-treatment HIV drug resistance in KwaZulu-Natal Province, South Africa. AIDS research and human retroviruses Chimukangara, B., Kharsany, A. B., Lessells, R. J., Naidoo, K., Rhee, S., Manasa, J., Graf, T., Lewis, L., Cawood, C., Khanyile, D., Diallo, K., Ayalew, K. A., Shafer, R., Hunt, G., Pillay, D., Abdool, S. K., de Oliveira, T. 2018


INTRODUCTION: There is evidence of increasing levels of pre-treatment HIV drug resistance (PDR) in Southern Africa. We used data from two large population-based HIV surveillance studies to estimate prevalence of PDR in KwaZulu-Natal, the province with the highest HIV prevalence in South Africa.METHODS: Sanger sequencing was performed on samples obtained from a longitudinal HIV surveillance programme (study A, 2013-2014) and the HIV Incidence Provincial Surveillance System (study B, 2014-2015). Sequences were included for adult HIV positive participants (age =15 years for study A, age 15-49 years for study B) with no documented prior exposure to ART. Overall and drug class-specific PDR was estimated using the World Health Organization 2009 surveillance drug resistance mutation (SDRM) list and phylogenetic analysis was performed to establish evidence of drug resistance transmission linkage.RESULTS: One thousand eight hundred and forty-five (1845) sequences were analysed (611 study A; 1234 study B). An overall PDR prevalence of 9.2% (95% confidence interval (CI): 7.0-11.7) was observed for study A and 11.0% (95% CI 8.9-13.2) for study B. In study B, the prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) PDR exceeded 10% for sequences collected in 2014 (10.2%, 95% CI 7.5-12.9). The most prevalent SDRMs were K103NS (7.5%), M184VI (2.4%) and V106AM (1.4%). There was no evidence of large transmission chains of drug-resistant virus.CONCLUSION: High level NNRTI-PDR (>10%) suggests a need to modify the standard first-line ART regimen and to focus attention on improving the quality of HIV prevention, treatment and care.

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