High Levels of Transmitted HIV Drug Resistance in a Study in Papua New Guinea.
BACKGROUND
Papua New Guinea is a Pacific Island nation of 7.3 million people with an estimated HIV prevalence of 0.8%. ART initiation and monitoring are guided by clinical staging and CD4 cell counts, when available. Little is known about levels of transmitted HIV drug resistance in recently infected individuals in Papua New Guinea.


METHODS
Surveillance of transmitted HIV drug resistance in a total of 123 individuals recently infected with HIV and aged less than 30 years was implemented in Port Moresby (n = 62) and Mount Hagen (n = 61) during the period May 2013-April 2014. HIV drug resistance testing was performed using dried blood spots. Transmitted HIV drug resistance was defined by the presence of one or more drug resistance mutations as defined by the World Health Organization surveillance drug resistance mutations list.


RESULTS
The prevalence of non-nucleoside reverse transcriptase inhibitor transmitted HIV drug resistance was 16.1% (95% CI 8.8%-27.4%) and 8.2% (95% CI 3.2%-18.2%) in Port Moresby and Mount Hagen, respectively. The prevalence of nucleoside reverse transcriptase inhibitor transmitted HIV drug resistance was 3.2% (95% CI 0.2%-11.7%) and 3.3% (95% CI 0.2%-11.8%) in Port Moresby and Mount Hagen, respectively. No protease inhibitor transmitted HIV drug resistance was observed.


CONCLUSIONS
The level of non-nucleoside reverse transcriptase inhibitor drug resistance in antiretroviral drug naïve individuals recently infected with HIV in Port Moresby is amongst the highest reported globally. This alarming level of transmitted HIV drug resistance in a young sexually active population threatens to limit the on-going effective use of NNRTIs as a component of first-line ART in Papua New Guinea. To support the choice of nationally recommended first-line antiretroviral therapy, representative surveillance of HIV drug resistance among antiretroviral therapy initiators in Papua New Guinea should be urgently implemented.
Central Public Health Laboratory, Port Moresby, Papua New Guinea.
Evelyn
E
Lavu
Central Public Health Laboratory, Port Moresby, Papua New Guinea.
Ellan
E
Kave
Central Public Health Laboratory, Port Moresby, Papua New Guinea.
Euodia
E
Mosoro
Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.
Jessica
J
Markby
Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.
Eman
E
Aleksic
Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.|Institute for Medical Research, Goroka, Papua New Guinea.
Janet
J
Gare
Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.
Imogen A
IA
Elsum
National Department of Health, Port Moresby, Papua New Guinea.
Gideon
G
Nano
Mount Hagen Hospital, Mount Hagen, Papua New Guinea.
Petronia
P
Kaima
National Department of Health, Port Moresby, Papua New Guinea.
Nick
N
Dala
World Health Organization, Port Moresby, Papua New Guinea.
Anup
A
Gurung
HIV Department, World Health Organization, Geneva, Switzerland.
Silvia
S
Bertagnolio
Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.
Suzanne M
SM
Crowe
Brixton Health, Llawryglyn, Powys, Wales, United Kingdom.
Mark
M
Myatt
Centre for Biomedical Research, Burnet Institute, Melbourne, Victoria, Australia.
Anna C
AC
Hearps
Division of Geographic Medicine and Infection Disease, Tufts Medical Center, Boston, Massachusetts, United States of America.|Tufts University School of Medicine, Boston, Massachusetts, United States of America.
Michael R
MR
Jordan
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission* / Q000821:virology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009154:Mutation; D010219:Papua New Guinea / Q000453:epidemiology; D010802:Phylogeny; D011159:Population Surveillance; D012367:RNA, Viral; D055815:Young Adult
D019380:Anti-HIV Agents; D012367:RNA, Viral