title: Increasing HIV-1 Drug Resistance Between 2010 and 2012 in Adults Participating in Population-Based HIV Surveillance in Rural KwaZulu-Natal, South Africa.
abstract: As more human immunodeficiency virus (HIV)-infected patients access combination antiretroviral therapy (cART), higher proportions of newly infected patients may be infected with drug-resistant viruses. Regular surveillance of transmitted drug resistance (TDR) is required in southern Africa where high rates of transmission persist despite rapid expansion of ART. Dried blood spot samples from cART-naive participants from two rounds of an annual population-based HIV surveillance program in rural KwaZulu-Natal were tested for HIV RNA, and samples with HIV RNA >10,000 copies/ml were genotyped for drug resistance. The 2009 surveillance of drug resistance mutation (SDRM) list was used for drug resistance interpretation. The data were added to previously published data from the same program, and the χ(2) test for trend was used to test for trend in estimated prevalence of any TDR. Seven hundred and one participants' data were analyzed: 67 (2010), 381 (2011), and 253 (2012). No TDR was detected in 2010. Years 2011 and 2012 had 18 participants with SDRMs 4.7% and 7.1%, respectively (p = .02, χ(2) test for trend). The nonnucleoside reverse transcriptase inhibitor mutation, K103N, was the most common mutation, occurring in 27 (3.8%) of the participants, while nucleoside reverse transcriptase inhibitor (NRTI) SDRMs were detected in 10 (1.4%) of the participants, of whom eight had only a single NRTI SDRM. The increase in levels of drug resistance observed in this population could be a signal of increasing transmission of drug-resistant HIV. Thus, continued surveillance is critical to inform public health policies around HIV treatment and prevention.
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .|2 Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University , Stanford, California.
authors.forename: Justen
authors.initials: J
authors.lastname: Manasa
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .
authors.forename: Siva
authors.initials: S
authors.lastname: Danaviah
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .|3 Department of Clinical Research, London School of Hygiene and Tropical Medicine , London, United Kingdom .
authors.forename: Richard
authors.initials: R
authors.lastname: Lessells
authors.affiliation: 4 School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal , Pietermaritzburg, KwaZulu-Natal, South Africa .
authors.forename: Muna
authors.initials: M
authors.lastname: Elshareef
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .
authors.forename: Frank
authors.initials: F
authors.lastname: Tanser
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .
authors.forename: Eduan
authors.initials: E
authors.lastname: Wilkinson
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .
authors.forename: Sureshnee
authors.initials: S
authors.lastname: Pillay
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .
authors.forename: Hloniphile
authors.initials: H
authors.lastname: Mthiyane
authors.affiliation: 4 School of Mathematics, Statistics and Computer Science, University of KwaZulu-Natal , Pietermaritzburg, KwaZulu-Natal, South Africa .
authors.forename: Henry
authors.initials: H
authors.lastname: Mwambi
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .
authors.forename: Deenan
authors.initials: D
authors.lastname: Pillay
authors.affiliation: 1 Africa Centre for Population Health, University of KwaZulu-Natal , Mtubatuba, KwaZulu-Natal, South Africa .|5 Research Department of Infection, University College of London (UCL) , London, United Kingdom .
authors.forename: Tulio
authors.initials: T
authors.lastname: de Oliveira
mesh_terms: D000328:Adult; D023241:Antiretroviral Therapy, Highly Active; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology; D054303:HIV Reverse Transcriptase / Q000235:genetics*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development; D006801:Humans; D008297:Male; D009154:Mutation; D062486:Public Health Surveillance; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D013019:South Africa / Q000453:epidemiology; D019562:Viral Load / Q000187:drug effects
chemical_list: D018894:Reverse Transcriptase Inhibitors; D054303:HIV Reverse Transcriptase