Transmitted, Pre-treatment and Acquired Antiretroviral Drug Resistance among Men who have Sex with Men and Transgender Women Living with HIV in Nigeria

Crowell, Trevor A; Kijak, Gustavo H.; Sanders‐Buell, Eric; O’Sullivan, Anne Marie; Kokogho, Afoke; Parker, Zahra; Lawlor, John; Polyak, Christina S.; Adebajo, Sylvia; Nowak, Rebecca G.; Baral, Stefan; Robb, Merlin L.; Charurat, Manhattan; Ake, Julie A; Ndembi, Nicaise; Tovanabutra, Sodsai

doi:10.3851/imp3342

Cited by 7 publications

(17 citation statements)

References 19 publications

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“…Delayed HIV diagnosis, interruptions of drug supply, limited access to third-line ART regimens, and late switches from failing regimens may each contribute to the temporal trend of increasing pretreatment HIVDR [ 27 , 28 ]. The country-level prevalence of pretreatment HIVDR was higher in our study than in previous reports from adults in Tanzania [ 29 , 30 ] and Nigeria [ 31–33 ]. In Kenya, prior studies have shown SDRM prevalence among ART-naive participants increasing from approximately 4%–5% in the early 2000s to around 10% in more recent years [ 32–35 ].…”

Section: Discussioncontrasting

confidence: 88%

Pretreatment and Acquired Antiretroviral Drug Resistance Among Persons Living With HIV in Four African Countries

Crowell

Danboise

Parikh

et al. 2020

Clinical Infectious Diseases

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Background Emerging HIV drug resistance (HIVDR) could jeopardize the success of standardized HIV management protocols in resource-limited settings. We characterized HIVDR among antiretroviral therapy (ART)-naïve and experienced participants in the African Cohort Study (AFRICOS). Methods From January 2013 to April 2019, adults with HIV-1 RNA >1000 copies/mL underwent ART history review and HIVDR testing upon enrollment at 12 clinics in Uganda, Kenya, Tanzania, and Nigeria. We calculated resistance scores for specific drugs and tallied major mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs) using Stanford HIVDB 8.8 and SmartGene IDNS software. For ART-naïve participants, World Health Organization surveillance drug resistance mutations (SDRMs) were noted. Results HIVDR testing was performed on 972 participants with median age 35.7 (interquartile range [IQR] 29.7-42.7) years and median CD4 295 (IQR 148-478) cells/mm3. Among 801 ART-naïve participants, the prevalence of SDRMs was 11.0%, NNRTI mutations 8.2%, NRTI mutations 4.5%, and PI mutations 0.4%. Among 171 viremic ART-experienced participants, NNRTI mutation prevalence was 83.6%, NRTI 67.8%, and PI 1.8%. There were 90 ART-experienced participants with resistance to both efavirenz and lamivudine, 32 (35.6%) of whom were still prescribed these drugs. There were ten with resistance to both tenofovir and lamivudine, 8 (80.0%) of whom were prescribed these drugs. Conclusions Participants on failing ART regimens had a high burden of HIVDR that potentially limited the efficacy of standardized first- and second-line regimens. Management strategies that emphasize adherence counseling while delaying ART switch may promote drug resistance and should be reconsidered.

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Section: Discussioncontrasting

confidence: 88%

Pretreatment and Acquired Antiretroviral Drug Resistance Among Persons Living With HIV in Four African Countries

Crowell

Danboise

Parikh

et al. 2020

Clinical Infectious Diseases

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“…Some of these cases could represent transmitted drug resistance. Other studies of African MSM have reported rates of transmitted drug resistance of 8.2% (Kenya ( Hassan et al, 2018 )) and 9.7% (Nigeria ( Crowell et al, 2020 )). However, it is also possible that one or more of the five participants in our cohort had prior exposure to an NNRTI for reasons other than ART (e.g., recreational EFV use ( Gatch et al, 2013 ; Rough et al, 2014 )).…”

Section: Discussionmentioning

confidence: 97%

“…In prior studies from Kenya and Nigeria, the rates of drug resistance among MSM who reported that they were ART-naive or initiating ART were 8.2% ( Hassan et al, 2018 ) and 9.7% ( Crowell et al, 2020 ), respectively. The study from Nigeria also detected drug resistance in 43% of ART-experienced MSM ( Crowell et al, 2020 ). Further studies are needed to assess ART, viral suppression, and drug resistance in among MSM and TGW in Africa.…”

Section: Introductionmentioning

confidence: 99%

“…As in other regions, ART outcomes in SSA are impacted by ART adherence and HIV drug resistance ( Gupta et al, 2012 ; Hogg et al, 2002 ; Lippman et al, 2020 ). Drug resistance has a greater impact on ART outcomes in regions of SSA and other resource-limited settings where drug resistance testing is not routinely used to guide HIV treatment ( Crowell et al, 2020 ).…”

Section: Introductionmentioning

confidence: 99%

“…In SSA and elsewhere, men who have sex with men (MSM) and transgender women (TGW) have a disproportionately high HIV burden ( Beyrer et al, 2012 ). In SSA, HIV prevalence among MSM and TGW has been reported at rates of 18%–55% ( Crowell et al, 2020 ; Keshinro et al, 2016 ; Sandfort et al, 2015 ; Wirtz et al, 2017 ). Reported HIV incidence rates among MSM and TGW in SSA are also higher than those seen in the general population (6.8 cases per 100 person-years (PY) among MSM ( Price et al, 2012 ) and 8.6 cases per 100 PY among MSM and TGW ( Sanders et al, 2013 ) as compared to 0.6–3.5 cases per 100 PY in the general population ( Braunstein et al, 2009 )).…”

Section: Introductionmentioning

confidence: 99%

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Uptake of antiretroviral treatment and viral suppression among men who have sex with men and transgender women in sub-Saharan Africa in an observational cohort study: HPTN 075

Palumbo

Zhang

Clarke

et al. 2021

International Journal of Infectious Diseases

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Objectives: HPTN 075 enrolled men who have sex with men (MSM) and transgender women (TGW) in sub-Saharan Africa. Persons in HIV care or on antiretroviral treatment (ART) were not eligible to enroll. We evaluated antiretroviral (ARV) drug use, viral suppression, and drug resistance in this cohort over a 12-month follow-up period. Methods: Assessments included 64 participants with HIV (39 MSM, 24 TGW, and one gender not specified). ARV drugs were detected using a qualitative assay. Viral load (VL) and drug resistance testing were performed using commercial assays. Results: Over 12 months, the proportion of participants using ARV drugs increased from 28.1% to 59.4% and the proportion with VLs <400 copies/mL increased from 21.9% to 57.8%. The rate of ART failure (detection of drugs without viral suppression) was similar at screening and 12 months (12.0% and 11.1%, respectively) and was similar among MSM and TGW. Two participants developed HIV drug resistance during follow-up. Conclusions: Over 12 months, ARV drug use in the cohort more than doubled and viral suppression increased nearly threefold without a significant increase in ART failure or drug resistance. These results suggest that ART can be successfully scaled up for HIV prevention and treatment in this high-risk population.

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HIV-1 drug resistance and genetic diversity in a cohort of people with HIV-1 in Nigeria

Oluniyi

Ajogbasile

Zhou

et al. 2021

Aids

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Objective: This study was designed to provide information on the genetic diversity of HIV-1 and drug resistance mutations in Nigeria, as there is limited understanding of variants circulating in the country. Methods: We used an advanced next-generation sequencing platform, Primer ID, to: investigate the presence of high and low abundance drug resistance mutations; characterize preexisting Integrase Strand Transfer Inhibitor (INSTI) mutations in antiretroviral therapy (ART)-experienced but dolutegravir-naive individuals; detect recent HIV-1 infections and characterize subtype diversity from a cohort of people with HIV-1 (PWH). Results: HIV-1 subtype analysis revealed the predominance of CRF02_AG and subtype G in our study population. At detection sensitivity of 30% abundance, drug resistance mutations (DRMs) were identified in 3% of samples. At a sensitivity level of 10%, DRMs were identified in 27.3% of samples. We did not detect any major INSTI mutation associated with dolutegravir-resistance. Only one recent infection was detected in our study population. Conclusion: Our study suggests that dolutegravir-containing antiretroviral regimens will be effective in Nigeria. Our study also further emphasizes the high genetic diversity of HIV-1 in Nigeria and that CRF02_AG and subtype G are the dominant circulating forms of HIV-1 in Nigeria. These two circulating forms of the virus are largely driving the epidemic in the country.

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Transmitted, Pre-treatment and Acquired Antiretroviral Drug Resistance among Men who have Sex with Men and Transgender Women Living with HIV in Nigeria

Cited by 7 publications

References 19 publications

Pretreatment and Acquired Antiretroviral Drug Resistance Among Persons Living With HIV in Four African Countries

Pretreatment and Acquired Antiretroviral Drug Resistance Among Persons Living With HIV in Four African Countries

Uptake of antiretroviral treatment and viral suppression among men who have sex with men and transgender women in sub-Saharan Africa in an observational cohort study: HPTN 075

HIV-1 drug resistance and genetic diversity in a cohort of people with HIV-1 in Nigeria

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