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Increasing Prevalence of HIV Pretreatment Drug Resistance in Women But Not Men in Rural Uganda During 2005-2013.
AIDS Patient Care STDS. 2018 07; 32(7):257-264.AP

Abstract

The prevalence of HIV pretreatment drug resistance (PDR) is increasing in sub-Saharan Africa. We sought to describe correlates of PDR and evaluate effects of PDR on clinical outcomes in rural Uganda. We analyzed data from the Uganda AIDS Rural Treatment Outcomes study, a cohort of antiretroviral therapy (ART)-naive adults with HIV (2005-2015). We performed resistance testing on pre-ART specimens. We defined PDR as any World Health Organization (WHO) 2009 surveillance drug resistance mutation and classified PDR level using the Stanford algorithm. We fit unadjusted and sex-stratified log binomial regression and Cox proportional hazard models to identify correlates of PDR and the impact of PDR on viral suppression, loss to follow-up (LTFU), and death. We analyzed data from 738 participants (median age 33 years, 69% female). Overall, prevalence of PDR was 3.5% (n = 26), owing mostly to resistance to non-nucleoside reverse transcriptase inhibitors. PDR increased over time in women (1.8% in those enrolling in clinic in 2001-2006, vs. 7.0% in 2007-2013; p = 0.006), but not in men (1.15% vs. 0.72%, p = 0.737). Lower pre-ART log10 HIV RNA was also associated with higher prevalence of PDR. We identified longer time to viral suppression among those with PDR compared with without PDR (0.5 and 0.3 years, respectively, p = 0.023), but there was no significant relationship with mortality or LTFU (p = 0.139). We observed increasing rates of PDR in women in southwestern Uganda. Implications of this trend, particularly to prevention of mother-to-child transmission programs in the region, require attention due to delayed viral suppression among those with PDR.

Authors+Show Affiliations

1 Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts. 2 Harvard Medical School , Boston, Massachusetts.2 Harvard Medical School , Boston, Massachusetts. 3 The Ragon Institute of MGH, MIT and Harvard, Cambridge, Massachusetts. 4 BC Center for Excellence in HIV/AIDS , Vancouver, Canada . 5 Department of Medicine, University of British Columbia , Vancouver, Canada .4 BC Center for Excellence in HIV/AIDS , Vancouver, Canada . 5 Department of Medicine, University of British Columbia , Vancouver, Canada .6 Mbarara University of Science and Technology , Mbarara, Uganda .6 Mbarara University of Science and Technology , Mbarara, Uganda .6 Mbarara University of Science and Technology , Mbarara, Uganda .6 Mbarara University of Science and Technology , Mbarara, Uganda .1 Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts. 2 Harvard Medical School , Boston, Massachusetts.7 Department of Medicine, University of California San Francisco , San Francisco, California.8 Department of Epidemiology and Biostatistics, University of California San Francisco, San Francisco, California.9 Epicenter Mbarara Research Center , Mbarara, Uganda .10 Oregon Health Sciences University-Portland State University School of Public Health , Portland, Oregon.5 Department of Medicine, University of British Columbia , Vancouver, Canada .1 Department of Medicine, Massachusetts General Hospital , Boston, Massachusetts. 2 Harvard Medical School , Boston, Massachusetts. 6 Mbarara University of Science and Technology , Mbarara, Uganda .

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

29985647

Citation

McCluskey, Suzanne M., et al. "Increasing Prevalence of HIV Pretreatment Drug Resistance in Women but Not Men in Rural Uganda During 2005-2013." AIDS Patient Care and STDs, vol. 32, no. 7, 2018, pp. 257-264.
McCluskey SM, Lee GQ, Kamelian K, et al. Increasing Prevalence of HIV Pretreatment Drug Resistance in Women But Not Men in Rural Uganda During 2005-2013. AIDS Patient Care STDS. 2018;32(7):257-264.
McCluskey, S. M., Lee, G. Q., Kamelian, K., Kembabazi, A., Musinguzi, N., Bwana, M. B., Muzoora, C., Haberer, J. E., Hunt, P. W., Martin, J. N., Boum, Y., Bangsberg, D. R., Harrigan, P. R., & Siedner, M. J. (2018). Increasing Prevalence of HIV Pretreatment Drug Resistance in Women But Not Men in Rural Uganda During 2005-2013. AIDS Patient Care and STDs, 32(7), 257-264. https://doi.org/10.1089/apc.2018.0020
McCluskey SM, et al. Increasing Prevalence of HIV Pretreatment Drug Resistance in Women but Not Men in Rural Uganda During 2005-2013. AIDS Patient Care STDS. 2018;32(7):257-264. PubMed PMID: 29985647.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Increasing Prevalence of HIV Pretreatment Drug Resistance in Women But Not Men in Rural Uganda During 2005-2013. AU - McCluskey,Suzanne M, AU - Lee,Guinevere Q, AU - Kamelian,Kimia, AU - Kembabazi,Annet, AU - Musinguzi,Nicholas, AU - Bwana,Mwebesa B, AU - Muzoora,Conrad, AU - Haberer,Jessica E, AU - Hunt,Peter W, AU - Martin,Jeffrey N, AU - Boum,Yap,2nd AU - Bangsberg,David R, AU - Harrigan,P Richard, AU - Siedner,Mark J, PY - 2018/7/10/entrez PY - 2018/7/10/pubmed PY - 2019/7/5/medline KW - HIV-1 KW - antiretroviral therapy KW - resistance KW - sub-Saharan Africa KW - viral suppression SP - 257 EP - 264 JF - AIDS patient care and STDs JO - AIDS Patient Care STDS VL - 32 IS - 7 N2 - The prevalence of HIV pretreatment drug resistance (PDR) is increasing in sub-Saharan Africa. We sought to describe correlates of PDR and evaluate effects of PDR on clinical outcomes in rural Uganda. We analyzed data from the Uganda AIDS Rural Treatment Outcomes study, a cohort of antiretroviral therapy (ART)-naive adults with HIV (2005-2015). We performed resistance testing on pre-ART specimens. We defined PDR as any World Health Organization (WHO) 2009 surveillance drug resistance mutation and classified PDR level using the Stanford algorithm. We fit unadjusted and sex-stratified log binomial regression and Cox proportional hazard models to identify correlates of PDR and the impact of PDR on viral suppression, loss to follow-up (LTFU), and death. We analyzed data from 738 participants (median age 33 years, 69% female). Overall, prevalence of PDR was 3.5% (n = 26), owing mostly to resistance to non-nucleoside reverse transcriptase inhibitors. PDR increased over time in women (1.8% in those enrolling in clinic in 2001-2006, vs. 7.0% in 2007-2013; p = 0.006), but not in men (1.15% vs. 0.72%, p = 0.737). Lower pre-ART log10 HIV RNA was also associated with higher prevalence of PDR. We identified longer time to viral suppression among those with PDR compared with without PDR (0.5 and 0.3 years, respectively, p = 0.023), but there was no significant relationship with mortality or LTFU (p = 0.139). We observed increasing rates of PDR in women in southwestern Uganda. Implications of this trend, particularly to prevention of mother-to-child transmission programs in the region, require attention due to delayed viral suppression among those with PDR. SN - 1557-7449 UR - https://www.unboundmedicine.com/medline/citation/29985647/Increasing_Prevalence_of_HIV_Pretreatment_Drug_Resistance_in_Women_But_Not_Men_in_Rural_Uganda_During_2005_2013_ L2 - https://www.liebertpub.com/doi/full/10.1089/apc.2018.0020?url_ver=Z39.88-2003&rfr_id=ori:rid:crossref.org&rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -