HIV-1 protease inhibitor drug resistance in Kenyan antiretroviral treatment-naive and -experienced injection drug users and non-drug users.
BACKGROUND
Although injection drug use drives antiretroviral drug resistance, the prevalence of protease inhibitor (PI) resistance among Kenyan IDUs remains undetermined. We, therefore, explored PI resistance mutations and their association with viral load and CD4+ T cell counts in HIV-1 infected IDUs (ART-naive, n = 32; and -experienced, n = 47) and non-drug users (ART-naive, n = 21; and -experienced, n = 32) naive for PI treatment from coastal Kenya.


RESULTS
Only IDUs harboured major PI resistance mutations consisting of L90M, M46I and D30 N among 3 (6.4 %) ART-experienced and 1 (3.1 %) -naive individuals. Minor PI mutations including A71T, G48E, G48R, I13V, K20I, K20R, L10I, L10V, L33F, L63P, T74S, V11I, and V32L were detected among the ART-experienced (36.2 vs. 46.9 %) and -naive (43.8 vs. 66.7 %) IDUs and non-drug users, respectively. All the four IDUs possessing major mutations had high viral load while three presented with CD4+ T cell counts of <500 cells/ml. Among the ART-naive non-drug users, CD4+ T cell counts were significantly lower in carriers of minor mutations compared to non-carriers (P < 0.05).


CONCLUSIONS
Transmitted drug resistance may occur in IDUs underscoring the need for genotyping resistance before initiating PI treatment.
Department of Environment and Health Sciences, Technical University of Mombasa, Mombasa, Kenya.
Valentine
V
Budambula
Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya ; Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya.
Francis O
FO
Musumba
Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya.
Mark K
MK
Webale
Department of Pharmacy and Complementary Medicine, Kenyatta University, Nairobi, Kenya.
Titus M
TM
Kahiga
Department of Medicine, Therapeutics, Dermatology and Psychiatry, Kenyatta University, Nairobi, Kenya.
Francisca
F
Ongecha-Owuor
Department of Obstetrics and Gynecology, University of Nairobi, Nairobi, Kenya.
James N
JN
Kiarie
Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, Kakamega, Kenya.
George A
GA
Sowayi
Bomu Hospital, Mombasa, Kenya.
Aabid A
AA
Ahmed
Department of Biomedical Science and Technology, Maseno University, Maseno, Kenya ; Health Challenges and Systems Program, African Population and Health Research Centre, Nairobi, Kenya.
Collins
C
Ouma
Department of Medical Laboratory Sciences, Masinde Muliro University of Science and Technology, P. O. Box 190, Kakamega, 50100 Kenya.
Tom
T
Were
Antiretroviral; Coastal Kenya; Drug resistance; HIV-1; Injection drug users; Non-drug users; Protease inhibitor; Treatment-experienced; Treatment-naive