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Prevalence of HIV-1 Drug Resistance among Women Screening for HIV Prevention Trials in KwaZulu-Natal, South Africa (MTN-009)

Parikh, UM and Kiepiela, P and Ganesh, S and Gomez, K and Horn, S and Eskay, K and Kelly, C and Mensch, B and Gorbach, P and Soto-Torres, L and Ramjee, G and Mellors, JW (2013) Prevalence of HIV-1 Drug Resistance among Women Screening for HIV Prevention Trials in KwaZulu-Natal, South Africa (MTN-009). PLoS ONE, 8 (4).

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Background:A major concern with using antiretroviral (ARV)-based products for HIV prevention is the potential spread of drug resistance, particularly from individuals who are HIV-infected but unaware of their status. Limited data exist on the prevalence of HIV infection or drug resistance among potential users of ARV-based prevention products.Methods:A cross-sectional study of reproductive-aged women who presented to screen for an HIV prevention trial was conducted at 7 clinical sites in Durban, South Africa. CD4+T cell counts, HIV-1 RNA levels and population sequencing of the protease and reverse transcriptase genes were performed for all women with 2 positive HIV rapid tests. Resistance mutations were identified using the Stanford Calibrated Population Resistance Tool.Results:Of the 1073 evaluable women, 400(37%) were confirmed as HIV-infected. Of those, plasma HIV-1 RNA was detectable in 365/400(91%) and undetectable(<40 copies/ml) in 35/400(9%) women. 156 women(39%) were eligible for antiretroviral therapy (CD4+T cell counts<350 cells/mm3) and 50(13%) met criteria for AIDS(CD4<200 cells/mm3). Of 352 plasma samples(>200 copies/ml) analyzed for drug resistance, 26(7.4%) had nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI) drug resistance mutations. Among those with resistance, 18/26 participants(62%) had single-class NNRTI resistance and 5/26(19%) had dual-class NRTI/NNRTI. Major mutations in reverse transcriptase included K65R(n = 1), L74I(n = 1), K103N(n = 19), V106M(n = 4), Y181C(n = 2), M184V(n = 4), and K219E/R(n = 2). Major PI-resistance mutations were rare: M46L(n = 1) and I85V(n = 1). All participants were infected with subtype C virus, except one infected with subtype A.Conclusions:In women from Durban, South Africa screening for an HIV prevention trial, the HIV prevalence was high (37%) and HIV drug resistance prevalence was above 5%. This study highlights the potential challenges faced when implementing an ARV-based prevention product that overlaps with first-line antiretroviral therapy. Effective screening to exclude HIV infection among women interested in uptake of ARV-based HIV prevention will be essential in limiting the spread of ARV resistance.


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Item Type: Article
Status: Published
CreatorsEmailPitt UsernameORCID
Parikh, UMump3@pitt.eduUMP3
Kiepiela, P
Ganesh, S
Gomez, K
Horn, S
Eskay, K
Kelly, C
Mensch, B
Gorbach, P
Soto-Torres, L
Ramjee, G
Mellors, JWjwm1@pitt.eduJWM1
ContributionContributors NameEmailPitt UsernameORCID
Date: 9 April 2013
Date Type: Publication
Journal or Publication Title: PLoS ONE
Volume: 8
Number: 4
DOI or Unique Handle: 10.1371/journal.pone.0059787
Schools and Programs: School of Medicine > Infectious Diseases and Microbiology
Refereed: Yes
Date Deposited: 03 May 2013 21:11
Last Modified: 22 Jun 2021 10:55


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