HIV Drug Resistance Patterns and Characteristics Associated with Clinically Significant Drug Resistance among Children with Virologic Failure on Antiretroviral Treatment in Kenya: Findings from the Opt4Kids Randomized Controlled Trial
Lisa Abuogi,
Patrick Oyaro,
Garoma Wakjira,
Katherine K. Thomas,
Andrea J. Scallon,
Irene Mukui,
Bhavna H. Chohan,
Evelyn Brown,
Enericah Karauki,
Nashon Yongo,
Bilaal Ahmed,
Shukri A. Hassan,
James Wagude,
Eunice Kinywa,
Linda Otieno,
Leonard Kingwara,
Boaz Oyaro,
Lisa M. Frenkel,
Grace John-Stewart,
Rena C. Patel
Affiliations
Lisa Abuogi
Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
Patrick Oyaro
Health Innovations Kenya (HIK), Kisumu 40100, Kenya
Garoma Wakjira
Department of Medicine, University of Washington, Seattle, WA 98195, USA
Katherine K. Thomas
Department of Global Health, University of Washington, Seattle, WA 98105, USA
Andrea J. Scallon
Department of Global Health, University of Washington, Seattle, WA 98105, USA
Irene Mukui
Drugs for Neglected Diseases Initiative (DNDI), Nairobi 21936, Kenya
Bhavna H. Chohan
Department of Global Health, University of Washington, Seattle, WA 98105, USA
Evelyn Brown
UWKenya, Nairobi 00200, Kenya
Enericah Karauki
UWKenya, Nairobi 00200, Kenya
Nashon Yongo
UWKenya, Nairobi 00200, Kenya
Bilaal Ahmed
Department of Pediatrics, University of Colorado, Denver, CO 80045, USA
Shukri A. Hassan
Department of Medicine, University of Washington, Seattle, WA 98195, USA
James Wagude
Department of Health, Ministry of Health, Siaya 40600, Kenya
Eunice Kinywa
Department of Health, Ministry of Health, Kisumu 40100, Kenya
Linda Otieno
Family AIDS Care and Education Services, Kenya Medical Research Institute, Kisumu 40100, Kenya
Leonard Kingwara
National HIV Reference Laboratory, Kenya Ministry of Health, Nairobi 00202, Kenya
Boaz Oyaro
Kenya Medical Research Institute-CDC, Kisumu 40100, Kenya
Lisa M. Frenkel
Department of Medicine, University of Washington, Seattle, WA 98195, USA
Grace John-Stewart
Department of Medicine, University of Washington, Seattle, WA 98195, USA
Rena C. Patel
Department of Medicine, University of Washington, Seattle, WA 98195, USA
Increasing HIV drug resistance (DR) among children with HIV (CHIV) on antiretroviral treatment (ART) is concerning. CHIV ages 1–14 years enrolled from March 2019 to December 2020 from five facilities in Kisumu County, Kenya, were included. Children were randomized 1:1 to control (standard-of-care) or intervention (point-of-care viral load (POC VL) testing every three months with targeted genotypic drug resistance testing (DRT) for virologic failure (VF) (≥1000 copies/mL)). A multidisciplinary committee reviewed CHIV with DRT results and offered treatment recommendations. We describe DR mutations and present logistic regression models to identify factors associated with clinically significant DR. We enrolled 704 children in the study; the median age was 9 years (interquartile range (IQR) 7, 12), 344 (49%) were female, and the median time on ART was 5 years (IQR 3, 8). During the study period, 106 (15%) children had DRT results (84 intervention and 22 control). DRT detected mutations associated with DR in all participants tested, with 93 (88%) having major mutations, including 51 (54%) with dual-class resistance. A history of VF in the prior 2 years (adjusted odds ratio (aOR) 11.1; 95% confidence interval (CI) 6.3, 20.0) and less than 2 years on ART at enrollment (aOR 2.2; 95% CI 1.1, 4.4) were associated with increased odds of major DR. DR is highly prevalent among CHIV on ART with VF in Kenya. Factors associated with drug resistance may be used to determine which children should be prioritized for DRT.
