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PLoS One. 2019 Oct 10;14(10):e0223829. doi: 10.1371/journal.pone.0223829. eCollection 2019.

HIV drug resistance in persons who inject drugs enrolled in an HIV prevention trial in Indonesia, Ukraine, and Vietnam: HPTN 074.

Author information

1
Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD, United States of America.
2
Vaccine and Infectious Disease Division, Fred Hutchinson Cancer Research Center, Seattle, WA, United States of America.
3
Frontier Science Foundation, Amherst, NY, United States of America.
4
Science Facilitation Department, Durham, NC, United States of America.
5
University of North Carolina Vietnam, Hanoi, Vietnam.
6
Gromashevsky Institute for Epidemiology and Infectious Diseases of the National Academy of Sciences of Ukraine, Kyiv, Ukraine.
7
University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
8
Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, United States of America.
9
Ukrainian Institute of Public Health Policy, Kyiv, Ukraine.
10
Departments of Hematology, Medical Oncology, and Medicine, University of Indonesia/Cipto Mangunkusumo Hospital, Jakarta, Indonesia.
11
Department of Medicine, University of North Carolina Chapel Hill School of Medicine, Chapel Hill, NC, United States of America.
12
Division of Epidemiology, College of Public Health, The Ohio State University, Columbus, OH, United States of America.

Abstract

BACKGROUND:

Persons who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We evaluated HIV drug resistance in PWID in a randomized clinical trial (HPTN 074). The study intervention included ART at any CD4 cell count with enhanced support for ART and substance use treatment.

METHODS:

HPTN 074 enrolled HIV-infected PWID (index participants) with viral loads ≥1,000 copies/mL and their HIV-uninfected injection-network partners in Indonesia, Ukraine, and Vietnam; the study limited enrollment of people who reported being on ART. HIV drug resistance testing and antiretroviral (ARV) drug testing were performed using samples collected from index participants at study enrollment.

RESULTS:

Fifty-four (12.0%) of 449 participants had HIV drug resistance; 29 (53.7%) of the 54 participants had multi-class resistance. Prevalence of resistance varied by study site and was associated with self-report of prior or current ART, detection of ARV drugs, and a history of incarceration. Resistance was detected in 10 (5.6%) of 177 newly diagnosed participants. Participants with resistance at enrollment were less likely to be virally suppressed after 52 weeks of follow-up, independent of study arm.

CONCLUSIONS:

In HPTN 074, many of the enrolled index participants had HIV drug resistance and more than half of those had multi-class resistance. Some newly-diagnosed participants had resistance, suggesting that they may have been infected with drug-resistant HIV strains. Behavioral and geographic factors were associated with baseline resistance. Baseline resistance was associated with reduced viral suppression during study follow-up. These findings indicate the need for enhanced HIV care in this high-risk population to achieve sustained viral suppression on ART.

Conflict of interest statement

We have read the journal's policy. None of the authors has a financial or personal relationship with other people or organizations that could inappropriately influence (bias) their work. Dr. Eshleman has collaborated on research studies with investigators from Abbott Diagnostics; Abbott Diagnostics provided reagents for some of those studies. Dr. Eshleman did not receive any funding or other support from Abbott Diagnostics. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

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