Surveillance of HIV-1 pol transmitted drug resistance in acutely and recently infected antiretroviral drug-naïve persons in rural western Kenya.
HIV-1 transmitted drug resistance (TDR) is of increasing public health concern in sub-Saharan Africa with the rollout of antiretroviral (ARV) therapy. Such data are, however, limited in Kenya, where HIV-1 drug resistance testing is not routinely performed. From a population-based household survey conducted between September and November 2012 in rural western Kenya, we retrospectively assessed HIV-1 TDR baseline rates, its determinants, and genetic diversity among drug-naïve persons aged 15-59 years with acute HIV-1 infections (AHI) and recent HIV-1 infections (RHI) as determined by nucleic acid amplification test and both Limiting Antigen and BioRad avidity immunoassays, respectively. HIV-1 pol sequences were scored for drug resistance mutations using Stanford HIVdb and WHO 2009 mutation guidelines. HIV-1 subtyping was computed in MEGA6. Eighty seven (93.5%) of the eligible samples were successfully sequenced. Of these, 8 had at least one TDR mutation, resulting in a TDR prevalence of 9.2% (95% CI 4.7-17.1). No TDR was observed among persons with AHI (n = 7). TDR prevalence was 4.6% (95% CI 1.8-11.2) for nucleoside reverse transcriptase inhibitors (NRTIs), 6.9% (95% CI 3.2-14.2) for non- nucleoside reverse transcriptase inhibitors (NNRTIs), and 1.2% (95% CI 0.2-6.2) for protease inhibitors. Three (3.4% 95% CI 0.8-10.1) persons had dual-class NRTI/NNRTI resistance. Predominant TDR mutations in the reverse transcriptase included K103N/S (4.6%) and M184V (2.3%); only M46I/L (1.1%) occurred in the protease. All the eight persons were predicted to have different grades of resistance to the ARV regimens, ranging from potential low-level to high-level resistance. HIV-1 subtype distribution was heterogeneous: A (57.5%), C (6.9%), D (21.8%), G (2.3%), and circulating recombinant forms (11.5%). Only low CD4 count was associated with TDR (p = 0.0145). Our findings warrant the need for enhanced HIV-1 TDR monitoring in order to inform on population-based therapeutic guidelines and public health interventions.
Center for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Harris
H
Onywera
Epicentre, Médecins Sans Frontières (MSF), Paris, France.
David
D
Maman
Center for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Seth
S
Inzaule
Center for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Erick
E
Auma
Center for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Kennedy
K
Were
Center for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Harrison
H
Fredrick
Center for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Prestone
P
Owiti
Center for Global Health Research (CGHR), Kenya Medical Research Institute (KEMRI), Kisumu, Kenya.
Valarie
V
Opollo
TransVIHMI IRD UMI 233 -INSERM U 1175 -Université de Montpellier, Montpellier, France.
Jean-François
JF
Etard
National AIDS and STI Control Programme (NASCOP), Ministry of Health, Nairobi, Kenya.
Irene
I
Mukui
US Centers for Disease Control and Prevention (CDC), Nairobi, Kenya.
Andrea A
AA
Kim
US Centers for Disease Control and Prevention (CDC), Kisumu, Kenya.
Clement
C
Zeh
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000145:classification / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008875:Middle Aged; D009154:Mutation; D010802:Phylogeny; D011159:Population Surveillance; D015995:Prevalence; D012307:Risk Factors; D019562:Viral Load; D055815:Young Adult; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics*
D019380:Anti-HIV Agents; D054302:pol Gene Products, Human Immunodeficiency Virus