TY - JOUR
T1 - Transmitted, pre-treatment and acquired antiretroviral drug resistance among men who have sex with men and transgender women living with HIV in Nigeria
AU - Crowell, Trevor A.
AU - Kijak, Gustavo H.
AU - Sanders-Buell, Eric
AU - O'Sullivan, Anne Marie
AU - Kokogho, Afoke
AU - Parker, Zahra F.
AU - Lawlor, John
AU - Polyak, Christina S.
AU - Adebajo, Sylvia
AU - Nowak, Rebecca G.
AU - Baral, Stefan D.
AU - Robb, Merlin L.
AU - Charurat, Manhattan E.
AU - Ake, Julie A.
AU - Ndembi, Nicaise
AU - Tovanabutra, Sodsai
N1 - Funding Information:
This work was supported by cooperative agreements between the Henry M Jackson Foundation for the Advancement of Military Medicine, Inc., and the US Department of Defense [W81XWH-11-2-0174, W81XWH-18-2-0040]; the National Institutes of Health [R01 MH099001, R01 AI120913, R01 MH110358]; Fogarty Epidemiology Research Training for Public Health Impact in Nigeria program [D43TW010051]; and the President’s Emergency Plan for AIDS Relief through a cooperative agreement between the Department of Health and Human Services/Centers for Disease Control and Prevention, Global AIDS Program, and the Institute for Human Virology-Nigeria [NU2GGH002099]. This work was presented, in part, at the 22nd International AIDS Conference in Amsterdam, the Netherlands, 23–27 July 2018. The views expressed are those of the authors and should not be construed to represent the positions of the US Army, Department of Defense, Henry M Jackson Foundation for the Advancement of Military Medicine, or the Department of Health and Human Services. The investigators have adhered to the policies for protection of human subjects as prescribed in AR-70. Further acknowledgements and TRUST/RV368 Study Group membership can be found in Additional file 1.
Publisher Copyright:
© 2019 International Medical Press Ltd. All rights reserved.
PY - 2019
Y1 - 2019
N2 - Background: Across sub-Saharan Africa, men who have sex with men (MSM) and transgender women (TGW) have disproportionately poor HIV treatment outcomes. Stigma and criminalization create barriers to health-care engagement and adherence to antiretroviral therapy (ART), potentially promoting the development of HIV drug resistance (HIVDR). We evaluated transmitted, pre-treatment and acquired HIVDR among MSM and TGW in Lagos and Abuja, Nigeria. Methods: Adults with HIV RNA =1,000 copies/ml in the TRUST/RV368 cohort, including incident cases diagnosed via 3-monthly screening, underwent HIVDR testing using the Sanger sequencing method. Major mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were identified from the 2017 IAS-USA list. World Health Organization surveillance drug resistance mutations (SDRMs) were identified in ART-naive participants. Results: From March 2013 to June 2017, 415 participants with median age 24 (interquartile range [IQR] 21-27) years, CD4+ T-cell count 370 (IQR 272-502) cells/mm3, and HIV RNA 4.73 (IQR 4.26-5.15) log10 copies/ml underwent HIVDR testing. SDRMs were observed in 36 of 373 ARTnaive participants (9.7%, 95% confidence interval [95% CI 6.8, 13.1%]), including 8 of 39 incident cases (20.5%, [95% CI] 9.3, 36.5%). Among 42 ART-experienced participants, NNRTI resistance was detected in 18 (42.9%, 95% CI 27.7, 59.0%) and NRTI resistance in 10 (23.8%, 95% CI 12.0, 39.4%). No PI resistance was detected. Conclusions: The high prevalence of transmitted and acquired drug resistance among Nigerian MSM and TGW living with HIV suggests the need for programmatic solutions to improve uninterrupted access to ART and timely switch to second-line regimens in cases of viral failure.
AB - Background: Across sub-Saharan Africa, men who have sex with men (MSM) and transgender women (TGW) have disproportionately poor HIV treatment outcomes. Stigma and criminalization create barriers to health-care engagement and adherence to antiretroviral therapy (ART), potentially promoting the development of HIV drug resistance (HIVDR). We evaluated transmitted, pre-treatment and acquired HIVDR among MSM and TGW in Lagos and Abuja, Nigeria. Methods: Adults with HIV RNA =1,000 copies/ml in the TRUST/RV368 cohort, including incident cases diagnosed via 3-monthly screening, underwent HIVDR testing using the Sanger sequencing method. Major mutations conferring resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors (PIs) were identified from the 2017 IAS-USA list. World Health Organization surveillance drug resistance mutations (SDRMs) were identified in ART-naive participants. Results: From March 2013 to June 2017, 415 participants with median age 24 (interquartile range [IQR] 21-27) years, CD4+ T-cell count 370 (IQR 272-502) cells/mm3, and HIV RNA 4.73 (IQR 4.26-5.15) log10 copies/ml underwent HIVDR testing. SDRMs were observed in 36 of 373 ARTnaive participants (9.7%, 95% confidence interval [95% CI 6.8, 13.1%]), including 8 of 39 incident cases (20.5%, [95% CI] 9.3, 36.5%). Among 42 ART-experienced participants, NNRTI resistance was detected in 18 (42.9%, 95% CI 27.7, 59.0%) and NRTI resistance in 10 (23.8%, 95% CI 12.0, 39.4%). No PI resistance was detected. Conclusions: The high prevalence of transmitted and acquired drug resistance among Nigerian MSM and TGW living with HIV suggests the need for programmatic solutions to improve uninterrupted access to ART and timely switch to second-line regimens in cases of viral failure.
UR - http://www.scopus.com/inward/record.url?scp=85085904089&partnerID=8YFLogxK
U2 - 10.3851/IMP3342
DO - 10.3851/IMP3342
M3 - Article
C2 - 32125280
AN - SCOPUS:85085904089
SN - 1359-6535
VL - 24
SP - 595
EP - 601
JO - Antiviral Therapy
JF - Antiviral Therapy
IS - 8
ER -