Institution: KEMRI

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Abstract

In 2019, the World Health Organization (WHO) estimated that there 1.5 million Kenyans were living with HIV, with 1.1 million on antiretroviral therapy (ART), of these few knew their resistance drug status. In this study, we evaluated the prevalence of drug resistance mutations to non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs), as well as the factors linked to drug resistance among patients failing treatment in Nairobi, Kenya.

This was a cross-sectional study, 128 HIV-positive plasma samples obtained from patients enrolled for routine viral monitoring in Nairobi clinics between 2015 and 2017 were utilized. Counts of Human Immunodeficiency virus type 1 (HIV-1) mutations conferring drug resistance was determined by Sanger sequencing of the polymerase (pol) gene followed by interpretation using Stanford’s HIV Drug Resistance Database. To determine the effects of sex, viral load, age, HIV-subtype, treatment duration, and ART-regimen on the count of mutations Poisson regression was used.

In this study, HIV-1 drug resistance mutations was observed in 82.3% of the subjects, with 45.2% exhibiting dual-class resistance and 15.3% displaying triple-class ART resistance. for NNRTIs, primary mutations identified K103N/S, G190A, and Y181C were found in 21.0%, 14.6%, and 10.9% of subjects respectively and for NRTIs, the primary mutations were M184V and K65R/E/N in 28.8% and 8.9% respectively. A statistically significant relationship between treatment duration and drug resistance mutations was found to vary by sex (P = .013). We found that each increase of one natural-log transformed viral load unit corresponded to an 11% rise in drug resistance mutation counts (incidence rate ratio [IRR] 1.11; 95% CI 1.06–1.16; P < .001). Patients on treatment for 31 to 60 months showed 63% higher resistance mutation counts (IRR 1.63; 95% CI 1.12–2.43; P = .013) compared to the reference group (<30 months). and those on ART for 61 to 90 months displayed 133% higher mutation counts (IRR 2.33; 95% CI 1.59–3.49; P < .001). However, HIV-1 subtype, age, and ART-regimen did not exhibit associations with resistance mutation counts.

High numbers of drug resistance mutations in treatment experienced patients indicate a need for targeted treatment monitoring.

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