Characteristics Associated with HIV Drug Resistance Among Women Screening for an HIV Prevention Trial in KwaZulu-Natal, South Africa
While the expansion of antiretroviral therapy (ART) in sub-Saharan Africa has reduced morbidity and mortality from HIV/AIDS, it has increased concern about drug resistance. The Microbicide Trials Network 009 study assessed the prevalence of drug-resistance mutations among women at clinical sites in Durban, South Africa who tested seropositive for HIV-1 at screening for the VOICE trial. The objective of this paper was to identify characteristics and behaviors associated with drug resistance. Factors found to be significantly associated with increased resistance were high perceived risk of getting HIV and prior participation in a microbicide trial, a likely proxy for familiarity with the health care system. Two factors were found to be significantly associated with reduced resistance: having a primary sex partner and testing negative for HIV in the past year. Other variables hypothesized to be important in identifying women with resistant virus, including partner or friend on ART who shared with the participant and being given antiretrovirals during pregnancy or labor, or the proxy variable—number of times given birth in a health facility—were not significantly associated. The small number of participants with resistant virus and the probable underreporting of sensitive behaviors likely affected our ability to construct a comprehensive profile of the type of HIV-positive women at greatest risk of developing resistance mutations.
KeywordsHIV drug resistance KwaZulu-Natal HIV-positive women screening for a prevention trial
We gratefully acknowledge the study participants, the communities and all the sites at which the study took place, health service providers, the South African Medical Research Council Institutional Review Board, and all of the MTN-009 Study Team including the clinical research site leaders Sarita Naidoo, Zakir Gaffoor, Marwah Jenneker, Zola Msiska, Arendevi Pather, Charlene Harichund, Sharika Gappoo, Jessica Philip, Nicola Coumi, Samantha Sukhdeo, Yuki Sookrajh, Leith Kwaan, Vijayanand Guddera and Brodie Daniels. We acknowledge the contributions of Benoit Masse, Paul Edelfsen and Karen Patterson from the Statistical Center for HIV/AIDS Research & Prevention (SCHARP). We also thank Stan Mierzwa and the Population Council IT team that designed and implemented the ACASI software, and Beth Galaska-Burzuk and Judy Jones from the MTN Core for their support during protocol development. The Microbicide Trials Network is funded by the National Institute of Allergy and Infectious Diseases (UM1AI068633, UM1AI068615, UM1AI106707), with co-funding from the Eunice Kennedy Shriver National Institute of Child Health and Human Development and the National Institute of Mental Health, all components of the U.S. National Institutes of Health.
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