Resistance to antiretroviral drugs in newly diagnosed, young treatment‐naïve HIV‐positive pregnant women in the province of KwaZulu‐Natal, South Africa

Abstract

In 2004, KwaZulu-Natal initiated one of the world's largest HIV/AIDS treatment programs. Studies in South Africa have shown that patients on antiretroviral therapy (ART) develop rapidly and transmit drug resistant mutations. Since resistance testing is not widely available in Kwazulu-Natal, the Department of Health conducted the first HIV drug resistance (HIVDR) threshold survey in 2005, which did not identify any mutations associated with HIVDR. The objective of this study was to conduct a follow-up threshold survey to update the information on HIVDR. This study was conducted in 2009 in five antenatal care sites in Kwazulu-Natal using the HIVDR threshold survey method developed by WHO. Two hundred and thirteen newly-diagnosed HIV positive, drug-naïve primigravidae, less than 22 years of age were included in the survey. Of the 82 HIV positive specimens, 17 had insufficient volume for genotyping and, of the remaining 65, 47 were genotyped sequentially. Drug resistance was identified by sequencing the HIV-1 pol gene, using the ViroSeq® HIV-1 genotyping system v2.0. Of the 47 samples that were genotyped, only one presented with a K103N mutation, which equates to a prevalence of transmitted HIVDR of <5%. The low prevalence of transmitted HIVDR is in keeping with statistical models of the early stages of ART rollout. As ART coverage is increasing continuously, there is a need to ensure that vigilance of HIVDR continues so that the emergence and spread of HIVDR is minimized.

Short Communication: High Prevalence of Transmitted Antiretroviral Drug Resistance Among Newly HIV Type 1 Diagnosed Adults in Mombasa, Kenya

“…[8][9][10]22,23 By contrast, recent surveys conducted in Kampala, 12 Dar es Salaam, 13 and Yaoundé 24 detected higher TDR rates (9-12%) compared to earlier estimates in the same regions, suggesting a trend of increasing TDR. Our study could unfortunately not be compared to an earlier survey in Mombasa.…”

Should we fear resistance from tenofovir/emtricitabine preexposure prophylaxis?

“…In a large meta-analysis evaluating 298 sequences from treatment-naïve individuals in Sub-Saharan Africa, only 6 (2%) had K65R while 54 (18%) had M184V (39). The World Health Organization (WHO) threshold surveillance classification for most regions in sub-Saharan Africa for NRTI resistance still remained low (<5%) except in KwaZulu-Natal, South Africa, where NRTI resistance has been reported as both low and moderate (5–15%) (40, 41). In a cross-sectional study of women screening for a prevention trials but ineligible to participate because of pre-existing HIV infection, only 1 of 400 (<1%) had K65R, and 4 of 400 (1%) had M184V (42).…”

Moderate Levels of Pre-Treatment HIV-1 Antiretroviral Drug Resistance Detected in the First South African National Survey

“…The detected prevalence in KwaZulu-Natal changed from low levels in 2005 and 2007 to moderate levels of TDR in 2008 and 2009 [13]. These moderate levels were confirmed by one study [15], but not by two additional studies from the region [16, 17]. A recent temporal analysis of transmitted drug resistance in KwaZulu-Natal showed an increase between 2010 and 2012 [18].…”