Viruses (Oct 2024)

Patterns of HIV-1 Drug Resistance Observed Through Geospatial Analysis of Routine Diagnostic Testing in KwaZulu-Natal, South Africa

  • Lilishia Gounder,
  • Aabida Khan,
  • Justen Manasa,
  • Richard Lessells,
  • Andrew Tomita,
  • Melendhran Pillay,
  • Sontaga C. Manyana,
  • Subitha Govender,
  • Kerri-Lee Francois,
  • Pravi Moodley,
  • Nokukhanya Msomi,
  • Kerusha Govender,
  • Raveen Parboosing,
  • Sikhulile Moyo,
  • Kogieleum Naidoo,
  • Benjamin Chimukangara

DOI
https://doi.org/10.3390/v16101634
Journal volume & issue
Vol. 16, no. 10
p. 1634

Abstract

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HIV-1 drug resistance (HIVDR) impedes treatment and control of HIV-1, especially in high-prevalence settings such as KwaZulu-Natal (KZN) province, South Africa. This study merged routine HIV-1 genotypic resistance test (GRT) data with Geographic Information Systems coordinates to assess patterns and geographic distribution of HIVDR in KZN, among ART-experienced adults with virological failure. We curated 3133 GRT records generated between 1 January 2018 and 30 June 2022, which includes the early phase of dolutegravir (DTG) rollout, of which 2735 (87.30%) had HIVDR. Of the 2735, major protease, nucleoside, and non-nucleoside reverse transcriptase inhibitor mutations were detected in 41.24%, 84.97% and 88.08% of GRTs, respectively. Additional genotyping of HIV-1 integrase for 41/3133 (1.31%) GRTs showed that 17/41 (41.46%) had integrase strand transfer inhibitor resistance. Notably, of 26 patients on DTG with integrase genotyping, 9 (34.62%) had DTG-associated resistance mutations. Dual- or triple-class resistance was observed in four of every five GRTs. The odds of HIVDR increased significantly with age, with ≥60 years having 5 times higher odds of HIVDR compared to 18–29 years (p = 0.001). We identified geospatial differences in the burden of HIVDR, providing proof of concept that this could be used for data-driven public health decision making. Ongoing real-time HIVDR surveillance is essential for evaluating the outcomes of the updated South African HIV treatment programme.

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