Pre-treatment hiv-1 drug resistance, virological outcomes and acquired hiv-1 drug resistance in a cohort of female sex workers in Uganda.
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BACKGROUND: Uganda adopted the WHO recommended test and treat among HIV infected individuals, which may pose a risk of HIV drug resistance (HIVDR) especially among high-risk populations. We investigated the risk factors for virological non-suppression, prevalence and patterns of HIVDR in a cohort of female sex workers (FSWs) in Uganda. METHODS: At enrollment, 320 HIV-infected FSWs were initiated on first-line antiretroviral therapy (ART) between 2015 and 2016 in a prospective study. Viral load (VL) testing was performed on participants at enrolment, 6, 12 and 24 months post ART initiation. Genotypic resistance testing by Sanger sequencing was performed on samples with VL>1000 copies/ml and HIVDR mutations assessed using the Stanford HIVDR database-algorithm. Risk factors for virological non-suppression and HIVDR were assessed in a logistic regression analysis. RESULTS: At baseline, pretreatment HIVDR mutations were detected in 4.4% (95% CI, 2.4 - 7.2) of FSWs. After 6, 12 and 24 months, virological suppression rates were reported at 87.1% (95% CI, 82.8-90.7), 83.0% (95% CI, 78.1-87.2) and 75.7% (95% CI, 69.98-80.77) respectively. An overall suppression rate of 82.21% (95% CI, 79.45-84.73) was observed in this high-risk cohort. Within 24 months of follow up, a total of 53 FSWs had acquired HIVDR mutations. Of these 53 FSWs, 75.5% and 37.7% had accumulated NNRTI and NRTI-based mutations respectively. The proportions of participants with acquired HIVDR mutations were estimated at 4.97% (95%, CI, 2.81- 8.06), 6.03% (95%, CI, 3.55-9.9.48) and 8.11% (95%; CI, 5.1-12.13) after 6, 12 and 24 months on ART respectively. Non-adherence nor other risk factors explored in a logistic regression analysis were associated with virological non-suppression or HIVDR among FSWs. CONCLUSIONS: The universal test and treat strategy can improve virological suppression rates in cohorts involved in high-risk behavior in Uganda. However, accumulation of NNRTI based mutations among FSWs highlights the need to maximize ART benefits through revision of the current standard first-line ART regimen, drug resistance testing and routine access to HIV viral load monitoring.