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HIV-1 drug resistance in a rural HIV clinic in Coastal Kenya.

HIV-1 drug resistance in a rural HIV clinic in Coastal Kenya. Amin Hassan KEMRI/ Wellcome Trust Research Programme, Kilifi , Kenya 22 nd November 2013. Layout. Background Objective Methods Results Summary Acknowledgement. HIV in Kenya. Generalized HIV epidemic

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HIV-1 drug resistance in a rural HIV clinic in Coastal Kenya.

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  1. HIV-1 drug resistance in a rural HIV clinic in Coastal Kenya. Amin Hassan KEMRI/Wellcome Trust Research Programme, Kilifi, Kenya 22nd November 2013

  2. Layout • Background • Objective • Methods • Results • Summary • Acknowledgement HIV-1 drug resistance in Kenya

  3. HIV in Kenya • Generalized HIV epidemic • Prevalence, 5.6% (Kenya AIDS Indicator Survey 2012) • People living with HIV, 1.6 million in 2011 (AIDS Epidemic Update 2011) • Scale up of antiretroviral therapy • 10000 (2003) to ~500000 (2012); 72% coverage (UNAIDS 2012) • Reduction in HIV-related morbidity and mortality • Emergence and transmission of HIVDR HIV-1 drug resistance in Kenya

  4. HIVDR in Kenya • Transmitted HIVDR: • Initially, low levels of <5% (Hamers R. et al, 2011; Price M. et al, 2011) • Recently, high prevalence: 9/68 (13.2%) (Sigaloff K. et al, 2012) • Acquired HIVDR: • Overall prevalence: 14/132 (10.6%) (Steegen K et al, 2009) • Predominant mutations: M184V, K103N • Paucity of HIVDR data from rural Kenya HIV-1 drug resistance in Kenya

  5. Objective • To describe HIV-1 transmitted and acquired drug resistance in a rural HIV clinic in Coastal Kenya. HIV-1 drug resistance in Kenya

  6. Study site HIV-1 drug resistance in Kenya

  7. Study setting • Standardised public health approach • ART eligibility: CD4 count <350 and/or WHO stage III/IV • First line: 2 NRTIs + 1 NNRTI • Second line: 2 NRTIs + boosted PI • Routine monitoring: Clinical and Immunological • Targeted monitoring: Virological and Drug resistance testing HIV-1 drug resistance in Kenya

  8. Study design • Cross sectional surveys, 2008 – 2011 • Eligibility: • Adults (>15 years) • Transmitted HIVDR: ART naïve, enrolling for HIV care • Acquired HIVDR: on 1st line ART, >6 months • Use of remnant samples from routine CD4 counts HIV-1 drug resistance in Kenya

  9. Laboratory methods • Plasma viral load quantification: • In house assay, viremia >400 cpm • HIVDR genotyping: • In-house assay (Cane P. , 2011) • Amplified and sequenced pol region • Sequences submitted to Stanford HIVDR database • TDR: WHO list for surveillance of TDR HIV-1 drug resistance in Kenya

  10. Transmitted HIVDR (N=182) • Females: 138 (76%) • Mean age: 35 years • Transmitted HIVDR: 2/182, 1.1% (95% CI, 0.1 – 3.9) HIV-1 drug resistance in Kenya

  11. Viremia and Acquired HIVDR (N=232) • Median duration on ART: 14 months (IQR: 10 - 18) • HIV-1 Viremia: 25% (95% CI: 19 - 31) • Acquired HIVDR: 13% (95% CI: 9 - 18 ) HIV-1 drug resistance in Kenya

  12. Acquired HIVDR mutations (N=29) Dual-class resistance, n= 25 (86%) HIV-1 drug resistance in Kenya

  13. Correlates of Viremia, Acquired DR (N=232) *Adjusted for gender, marital status, education status, baseline regimen, drug substitution and duration on ART. HIV-1 drug resistance in Kenya

  14. Viremia and Acquired HIVDR by age (N=232) HIV-1 drug resistance in Kenya

  15. Limitations • Generalizability • Transmitted HIVDR: • Inability to determine acute HIV infections • Reported ART exposure • Acquired HIVDR: • Cross sectional design, one-off plasma viral load HIV-1 drug resistance in Kenya

  16. Summary • Conclusions • Low levels of transmitted HIVDR; geographic variations • Viremia and Acquired HIVDR comparable to other settings • Recommendations • Continued surveillance for transmitted and acquired HIVDR • Prioritize and strengthen adherence support • Youth friendly ART support and initiatives HIV-1 drug resistance in Kenya

  17. Acknowledgement • KEMRI/Wellcome Trust Research Programme • James Berkley • Eduard Sanders • PASER / University of Amsterdam • Tobias F. Rinke de Wit • Health Protection Agency, London • Pat Cane • Antiviral unit • Patients and staff at the HIV clinic, Kilifi District Hospital HIV-1 drug resistance in Kenya

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