Antiretroviral drug use and HIV drug resistance in female sex workers in Tanzania and the Dominican Republic

Abstract

Objective Female sex workers (FSW) have increased risk of HIV infection. Antiretroviral treatment (ART) can improve HIV outcomes and prevent HIV transmission. We analyzed antiretroviral (ARV) drug use and HIV drug resistance among HIV-positive FSW in the Dominican Republic and Tanzania. Methods Plasma samples collected at study entry with viral loads >1,000 copies/mL were tested for ARV drugs and HIV drug resistance. ARV drug testing was performed using a qualitative assay that detects 22 ARV drugs in five classes. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System. Phylogenetic analyses were performed to determine HIV subtype and assess transmission clusters. Results Among 410 FSW, 144 (35.1%) had viral loads >1,000 copies/mL (DR: n = 50; Tanzania: n = 94). ARV drugs were detected in 36 (25.0%) of 144 samples. HIV genotyping results were obtained for 138 (95.8%) cases. No transmission clusters were observed in either country. HIV drug resistance was detected in 54 (39.1%) of 138 samples (31/35 [88.6%] with drugs detected; 23/103 [22.3%] without drugs detected); 29/138 (21.0%) had multi-class resistance (MCR). None with MCR had integrase strand transfer inhibitor resistance. In eight cases, one or more ARV drug was detected without corresponding resistance mutations; those women were at risk of acquiring additional drug resistance. Using multivariate logistic regression, resistance was associated with ARV drug detection (p<0.001), self-reported ART (full adherence [p = 0.034]; partial adherence [p<0.001]), and duration of HIV infection (p = 0.013). Conclusions In this cohort, many women were on ART, but were not virally suppressed. High levels of HIV drug resistance, including MCR, were observed. Resistance was associated with detection of ARV drugs, self-report of ART with full or partial adherence, and duration of HIV infection. These findings highlight the need for better HIV care among FSW to improve their health, reduce HIV drug resistance, and decrease risk of transmission to others.

Evaluating Barriers to Viral Suppression among People with HIV in Santiago, Dominican Republic

“…Patients who are on second-line regimens are more likely to be at risk for virologic failure due to existing difficulties with ART adherence and possibly undiagnosed drug resistance. 22 – 24 Other contributing factors include the greater pill burden, more complicated dosing schedules, and higher rates of adverse effects known to be associated with PI-based regimens. 25 , 26 Access to genotype testing is limited for PWH in the DR, and ART regimens are frequently changed based on HIV disease progression, lack of viral suppression and the availability of medications in the hospital pharmacy.…”

“…The rate of virologic failure to certain ART regimens due to drug resistance is unknown, though one small study detected at least one antiretroviral class mutation in 54% of samples from the DR, with 24% of patients having multi-class resistance. 23 …”

“…The rate of virologic failure to certain ART regimens due to drug resistance is unknown, though one small study detected at least one antiretroviral class mutation in 54% of samples from the DR, with 24% of patients having multi-class resistance. 23 The DR Ministry of Health has updated the national HIV treatment guidelines, and in 2019 Dolutegravir was included and made available as a first-line agent in combination with a dual nucleoside reverse transcriptase inhibitor (NRTI) backbone. This once-daily combination regimen has been shown to have improved efficacy, tolerability and is particularly important given that some low-and middle-income countries report a pretreatment drug resistance to Efavirenz of over 10%.…”

Adesão À Terapia Antirretroviral Em Mulheres: Influência Do Perfil Clínico E Comportamental De Saúde

“…O maior tempo de convívio com a infecção pode facilitar o conhecimento acerca da importânica da adesão medicamentosa, para supressão virológica do HIV (14) . Por outro lado, a cronificação do tratamento dificulta a adesão ao longo dos anos, pela probabilidade da resistência aos medicamentos e pela necessidade de tomada diária dos remédios (15) .…”

Exploring gender differences in HIV-related stigma and social support in a low-resource setting: A qualitative study in the Dominican Republic

“…Women represent more than half of the adults living with HIV in the DR, in comparison to Latin America where men are overrepresented in the proportion of PLHIV [ 21 ]. A study with PLHIV engaged in sex work in the DR and Tanzania found many women had not achieved viral suppression, had high rates of HIV drug resistance, and suboptimal ART adherence [ 22 ].…”