Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross sectional study
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Date
2019
Journal Title
Journal ISSN
Volume Title
Publisher
Sexually transmitted infections
Abstract
We assessed the prevalence and risk factors
associated with virological failure among female sex
workers living with HIV on antiretroviral therapy (ART ) in
Kampala, Uganda.
Methods We conducted a cross-sectional study
between January 2015 and December 2016 using
routinely collected data at a research clinic providing
services to women at high risk of STIs including HIV.
Plasma samples were tested for viral load from HIVseropositive
women aged ≥18 years who had been on
ART for at least 6 months and had received adherence
counselling. Samples from women with virological failure
(≥1000 copies/mL) were tested for HIV drug resistance
by population-based sequencing. We used logistic
regression to identify factors associated with virological
failure.
Results Of 584 women, 432 (74%) with a mean age
of 32 (SD 6.5) were assessed, and 38 (9%) were found
to have virological failure. HIV resistance testing was
available for 78% (28/38), of whom 82.1% (23/28)
had at least one major drug resistance mutation (DRM),
most frequently M184V (70%, 16/23) and K103N (65%,
15/23). In multivariable analysis, virological failure was
associated with participant age 18–24 (adjusted OR
(aOR)=5.3, 95% CI 1.6 to 17.9), self-reported ART nonadherence
(aOR=2.6, 95% CI 1.2 to 5.8) and baseline
CD4+ T-cell count ≤350 cells/mm3 (aOR=3.1, 95% CI
1.4 to 7.0).
Conclusions A relatively low prevalence of virological
failure but high rate of DRM was found in this population
at high risk of transmission. Younger age, self-reported
ART non-adherence and low CD4+ T-cell count on
ART initiation were associated with increased risk of
virological failure.
Description
Keywords
Drug resistance, Female sex workers, HIV, Antiretroviral therapy, Uganda
Citation
Namale, G., Kamacooko, O., Bagiire, D., Mayanja, Y., Abaasa, A., Kilembe, W., ... & Seeley, J. (2019). Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross-sectional study. Sexually transmitted infections, 95(6), 405-411. doi:10.1136/sextrans-2018-053854