High level of pre-treatment and acquired HIV drug resistance in Honduras: a nationally representative survey, 2016–17. (17th April 2020)

• Record Type: Journal Article
• Authors: Girón-Callejas, Amalia; García-Morales, Claudia; Mendizabal-Burastero, Ricardo; Meza, Rita I; Sierra, Tomasa; Tapia-Trejo, Daniela; Pérez-García, Marissa; Quiroz-Morales, Verónica S; Paredes, Mayte; Rodríguez, Alizon; Juárez, Sandra I; Farach, Nasim; Videa, Geraldina; Lara, Bredy; Rodríguez, Edith; Ardón, Elvia; Sajquim, Edgar; Lorenzana, Rolando; Ravasi, Giovanni; Northbrook, Sanny; Reyes-Terán, Gustavo; Ávila-Ríos, Santiago
• Is Part Of: Journal of antimicrobial chemotherapy. Volume 75:Number 7(2020)
• Page Start: 1932
• Page End: 1942
• Publication Date: 2020-04-17
• Subjects: Anti-infective agents -- Periodicals; Chemotherapy -- Periodicals; 615.58
• DOI: 10.1093/jac/dkaa100
• Languages: English
• ISSNs: 0305-7453

Abstract

Abstract: Background: Pre-treatment HIV drug resistance (HIVDR) to NNRTIs has consistently increased in low-/middle-income countries during the last decade. Objectives: To estimate the prevalence of pre-treatment HIVDR and acquired HIVDR among persons living with HIV (PLHIV) on ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48) in Honduras. Patients and methods: A nationwide cross-sectional survey with a two-stage cluster sampling was conducted from October 2016 to November 2017. Twenty-two of 54 total ART clinics representing >90% of the national cohort of adults on ART were included. HIVDR was assessed for protease and reverse transcriptase Sanger sequences using the Stanford HIVdb tool. Results: A total of 729 PLHIV were enrolled; 26.3% (95% CI 20.1%–33.5%) ART initiators reported prior exposure to antiretrovirals. Pre-treatment HIVDR prevalence was 26.9% (95% CI 20.2%–34.9%) to any antiretroviral and 25.9% (19.2%–33.9%) to NNRTIs. NNRTI pre-treatment HIVDR was higher in ART initiators with prior exposure to antiretrovirals ( P = 0.001). Viral load (VL) suppression rate was 89.7% (85.1%–93.0%) in ADR12 and 67.9% (61.7%–73.6%) in ADR48. ADR12 to any drug among PLHIV with VL ≥1000 copies/mL was 86.1% (48.9%–97.6%); 67.1% (37.4%–87.5%) had HIVDR to both NNRTIs and NRTIs, and 3.8% (0.5%–25.2%) to PIs. ADR48 was 92.0% (86.8%–95.3%) to any drug; 78.1% (66.6%–86.5%) to both NNRTIs and NRTIs, and 7.3% (1.8%–25.1%) to PIs. Conclusions: The high prevalence of NNRTI pre-treatment HIVDR observed in Honduras warrants consideration of non-NNRTI-based first-line regimens for ART initiation. Programmatic improvements in HIVDR monitoring and adherence support may also be considered.