Prevalence of HIV-1 drug resistance among women screening for HIV prevention trials in KwaZulu-Natal, South Africa (MTN-009)
Background: A major concern with using antiretroviral (ARV)-based products for HIV prevention is the potential spread of drug resistance, particularly from individuals who are HIV-infected but unaware of their status. Limited data exist on the prevalence of HIV infection or drug resistance among potential users of ARV-based prevention products. Methods: A cross-sectional study of reproductive-aged women who presented to screen for an HIV prevention trial was conducted at 7 clinical sites in Durban, South Africa. CD4+T cell counts, HIV-1 RNA levels and population sequencing of the protease and reverse transcriptase genes were performed for all women with 2 positive HIV rapid tests. Resistance mutations were identified using the Stanford Calibrated Population Resistance Tool. Results: Of the 1073 evaluable women, 400 (37%) were confirmed as HIV-infected. Of those, plasma HIV-1 RNA was detectable in 365/400 (91%) and undetectable (/ml) in 35/400 (9%) women. 156 women (39%) were eligible for antiretroviral therapy (CD4+T cell counts < 350 cells/mm^3) and 50 (13%) met criteria for AIDS (CD4 < 200 cells/mm^3). Of 352 plasma samples ( > 200 copies/ml) analyzed for drug resistance, 26 (7.4%) had nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) drug resistance mutations. Among those with resistance, 18/26 participants (62%) had single-class NNRTI resistance and 5/26 (19%) had dual-class NRTI/NNRTI. Major mutations in reverse transcriptase included K65R(n = 1), L74I(n = 1), K103N(n = 19), V106M(n = 4), Y181C(n = 2), M184V(n = 4), and K219E/R(n = 2). Major PI-resistance mutations were rare: M46L(n = 1) and I85V(n = 1). All participants were infected with subtype C virus, except one infected with subtype A. Conclusions: In women from Durban, South Africa screening for an HIV prevention trial, the HIV prevalence was high (37%) and HIV drug resistance prevalence was above 5%. This study highlights the potential challenges faced when implementing an ARV-based prevention product that overlaps with first-line antiretroviral therapy. Effective screening to exclude HIV infection among women interested in uptake of ARV-based HIV prevention will be essential in limiting the spread of ARV resistance.
Parikh, Urvi M., Photini Kiepiela, Shayhana Ganesh, Kailazarid Gomez, Stephanie Horn, Krista Eskay, Cliff Kelly, Barbara Mensch, Pamina M. Gorbach, Lydia Soto-Torres, Gita Ramjee, John W. Mellors, and on behalf of IPTc Taskforce. 2013. "Prevalence of HIV-1 drug resistance among women screening for HIV prevention trials in KwaZulu-Natal, South Africa (MTN-009)," PLoS ONE 8(4): e59787.