title: Prevalence of transmitted HIV-1 drug resistance among young adults attending HIV counselling and testing clinics in Kigali, Rwanda.
abstract: Scaling-up antiretroviral therapy (ART) in resource-limited settings has raised concerns of emerging HIV drug resistance (DR) and its transmission to newly infected individuals. To assess the prevalence of transmitted drug resistance (TDR) in recently HIV-infected individuals, a WHO TDR threshold survey was conducted among young adults in Kigali, Rwanda.
  
  
  
  Between May and July 2011, HIV subtype and genotyping were performed on dried blood spots (DBS) prepared from blood specimens collected from newly HIV-diagnosed and ART-naive individuals aged 15 to 21 years in eight HIV voluntary counselling and testing (VCT) sites in Kigali.
  
  
  
  In total, 57 of the 68 DBS collected from eligible participants were successfully amplified. The median age of participants was 20 years and 86% were female. Most participants (96%) were infected with subtype A1 virus. Two participants (4%) had the K103N non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation and one (2%) had the M46L protease inhibitor (PI) mutation. The TDR prevalence was 3.5% (95% CI 0.4, 12.1) for NNRTI and 1.8% (95% CI 0.0, 9.4) for PI.
  
  
  
  The prevalence of HIV TDR in VCT attendees in Kigali was characterized as low (<5%) for all drug classes according to the WHO HIV DR threshold survey methodology. Despite a decade of widespread ART in Rwanda, TDR prevalence remains low, and so the current first-line ART regimens should continue to be effective. However, as scale-up of ART continues, frequent HIV DR surveillance is needed to monitor the effectiveness of available ART regimens at the population level.
authors.affiliation: Rwanda Biomedical Center, Kigali, Rwanda.
authors.forename: Mwumvaneza
authors.initials: M
authors.lastname: Mutagoma
authors.forename: Jean d'Amour
authors.initials: Jd
authors.lastname: Ndahimana
authors.forename: Eugenie
authors.initials: E
authors.lastname: Kayirangwa
authors.forename: Anicet G
authors.initials: AG
authors.lastname: Dahourou
authors.forename: Helen
authors.initials: H
authors.lastname: Balisanga
authors.forename: Joshua R
authors.initials: JR
authors.lastname: DeVos
authors.forename: David
authors.initials: D
authors.lastname: McAlister
authors.forename: Chunfu
authors.initials: C
authors.lastname: Yang
authors.forename: Silvia
authors.initials: S
authors.lastname: Bertagnolio
authors.forename: David J
authors.initials: DJ
authors.lastname: Riedel
authors.forename: Sabin
authors.initials: S
authors.lastname: Nsanzimana
mesh_terms: D000293:Adolescent; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D009154:Mutation; D015995:Prevalence; D012432:Rwanda / Q000453:epidemiology; D055815:Young Adult