HIV drug resistance in persons who inject drugs enrolled in an HIV prevention trial in Indonesia, Ukraine, and Vietnam: HPTN 074


Autoři: Philip J. Palumbo aff001;  Yinfeng Zhang aff001;  Jessica M. Fogel aff001;  Xu Guo aff002;  William Clarke aff001;  Autumn Breaud aff001;  Paul Richardson aff001;  Estelle Piwowar-Manning aff001;  Stephen Hart aff003;  Erica L. Hamilton aff004;  Ngo T. K. Hoa aff005;  Mariya Liulchuk aff006;  Latifah Anandari aff007;  Tran Viet Ha aff008;  Kostyantyn Dumchev aff009;  Zubairi Djoerban aff010;  Irving Hoffman aff011;  Brett Hanscom aff002;  William C. Miller aff012;  Susan H. Eshleman aff001
Působiště autorů: Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America aff001;  Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America aff002;  Frontier Science Foundation, Amherst, NY, United States of America aff003;  Science Facilitation Department, Durham, NC, United States of America aff004;  University of North Carolina Vietnam, Hanoi, Vietnam aff005;  Gromashevsky Institute for Epidemiology and Infectious Diseases of the National Academy of Sciences of Ukraine, Kyiv, Ukraine aff006;  University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia aff007;  Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America aff008;  Ukrainian Institute of Public Health Policy, Kyiv, Ukraine aff009;  Departments of Hematology, Medical Oncology, and Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia aff010;  Department of Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC, United States of America aff011;  Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America aff012
Vyšlo v časopise: PLoS ONE 14(10)
Kategorie: Research Article
doi: 10.1371/journal.pone.0223829

Souhrn

Background

Persons who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We evaluated HIV drug resistance in PWID in a randomized clinical trial (HPTN 074). The study intervention included ART at any CD4 cell count with enhanced support for ART and substance use treatment.

Methods

HPTN 074 enrolled HIV-infected PWID (index participants) with viral loads ≥1,000 copies/mL and their HIV-uninfected injection-network partners in Indonesia, Ukraine, and Vietnam; the study limited enrollment of people who reported being on ART. HIV drug resistance testing and antiretroviral (ARV) drug testing were performed using samples collected from index participants at study enrollment.

Results

Fifty-four (12.0%) of 449 participants had HIV drug resistance; 29 (53.7%) of the 54 participants had multi-class resistance. Prevalence of resistance varied by study site and was associated with self-report of prior or current ART, detection of ARV drugs, and a history of incarceration. Resistance was detected in 10 (5.6%) of 177 newly diagnosed participants. Participants with resistance at enrollment were less likely to be virally suppressed after 52 weeks of follow-up, independent of study arm.

Conclusions

In HPTN 074, many of the enrolled index participants had HIV drug resistance and more than half of those had multi-class resistance. Some newly-diagnosed participants had resistance, suggesting that they may have been infected with drug-resistant HIV strains. Behavioral and geographic factors were associated with baseline resistance. Baseline resistance was associated with reduced viral suppression during study follow-up. These findings indicate the need for enhanced HIV care in this high-risk population to achieve sustained viral suppression on ART.

Klíčová slova:

Antimicrobial resistance – Antiretroviral therapy – Antiretrovirals – Drug screening – HIV – HIV epidemiology – HIV prevention – Viral load


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PLOS One


2019 Číslo 10

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