HIV pretreatment drug resistance among cisgender MSM and transgender women from Lima, Peru

Abstract

Introduction Transmitted, or any pretreatment drug resistance (TDR, PDR) can compromise efficacy of first‐line antiretroviral therapy (ART). In Peru, genotypic resistance testing is not routinely performed before ART initiation, and estimated PDR prevalence prior to 2012 ranged from 1.0% to 4.7%. We aimed to update estimates of PDR prevalence in men who have sex with men (cis‐MSM) and transgender women (TW). Methods We obtained HIV sequences from three studies of ART‐naïve cisgender‐MSM and TW (n = 470) in Lima, Peru from 2013 to 2017, almost two‐thirds of whom had acute or recent infections. Sanger sequences of HIV pol were interrogated for surveillance drug resistance mutations (SDRM) using the Stanford Calibrated Population Resistance (CPR) tool and scored for resistance to nucleoside reverse transcriptase inhibitors (NRTIs) and non‐nucleoside reverse transcriptase inhibitors (NNRTIs) with the HIVdb programme. We calculated binomial proportions and 95% confidence intervals. χ2 and exact or trend tests were used to examine predictors of PDR. Results Seventy‐seven (16.4%) individuals had PDR (95% CI: 13.2 to 20.0); most resistance was likely TDR since 63% were incident infections. SDRM were present in 9.8% (7.3 to 12.9). Resistance to any NRTI was present in <1% of individuals, while efavirenz resistance was present in 10% (6.9% to 12.4%). TW were not statistically more likely than cis‐MSM to have PDR (11.4% vs. 9.1%, p = 0.54). Age, incident versus prevalent infection, or residence district did not predict PDR. Prevalence of SDRM increased from 3% in 2013 to 21% 2017 within incident infections (p = 0.04), but not when including prevalent infections. Conclusions Prevalence of NNRTI resistance in three studies of ART‐naïve MSM and TW in Lima, Peru reaches 10%. Because our study reports PDR in a population in which most acquired HIV recently, the overall prevalence of PDR, including previously treated persons, is likely underestimated. These results underscore the need for a nationally representative survey of PDR in Peru and consideration of non‐NNRTI anchored first‐line ART options. This study also represents the first evaluation of PDR in cis‐MSM versus TW in South America, and demonstrates that, although TW are at higher risk of acquiring HIV, they are at similar risk of acquiring a virus with resistance mutations.

Increase in HIV-1 transmitted drug resistance among untreated 16~25-y-old youths in the China-Myanmar border areas during 2009~2017

“…Azidothymidine (AZT), lamivudine (3TC), and tenofovir (TDF), as rst-line NRTI drugs in China, have meager rates of transmission resistance (0.3%, 0.15%, and 0%, respectively). However, unlike the ndings reported in other studies, [4,5,[36][37][38][39][40] NRTI resistance showed the most signi cant increase (from 0% to 5.17%) from 2009 to 2017 in this study. Although the prevalence of TDR to PIs (0.44%) was signi cantly lower than the prevalence of TDR to NNRTIs/NRTIs, the I54M mutation caused universal resistance to PI drugs.…”

“…[3] TDR has been detected in ART-naïve populations in the United States, Switzerland, Peru, Argentina, Brazil, and Colombia, and the estimate of the number of people infected with virus carrying TDR mutations has increased with time. [3][4][5] In these populations, demographic and clinical characteristics usually cannot predict TDR. Interestingly, some studies reported higher CD4 counts in people with TDR mutations (TDRMs) than in individuals without TDRMs, [6,7] but others came to the opposite conclusion.…”

Mental Health and HIV-related Risky Sexual Behaviors Among Cisgender, Transgender, and Gender Non- Conforming MSM in China

“…The study showed that the prevalence of transgender and gender non-conforming identifying MSM accounted for 8.8% of the total population. A previous study reported that 23% of sample were identi ed as gender minorities among the MSM population [5], while yet another study found that 9% of the MSM population were identi ed as transgender women [19]. This existing discrepancies among different studies could be attributed to various assessment tools of gender identify, different districts, and cultural norms, etc.…”

“…In recent studies, there has been a call for further analysis of gender identity among men who have sex with men (MSM) for HIV interventions around the world [3,4]. Previous international studies have shown that transgender and gender non-conforming MSM account for over 23% of the MSM population [5]. In Jobson's survey of one city of South African, it was also reported that 9% of individuals identi ed as gender minorities among the MSM population [6].…”

Psychosocial characteristics and HIV-related risky sexual behaviors among cisgender, transgender, and gender non-conforming MSM in China

“…In recent studies around the world, there has been a call for further analysis of HIV interventions that target different gender identities among men who have sex with men (MSM) [3][4][5]. Previous research has shown that transgender and gender non-conforming MSM account for over 23% of the MSM population in Peru [6]. Jobson et al found that 9% of individuals were identi ed as gender minorities within the MSM population in a city of South Africa [7].…”