Department of Translational Medicine, Lund University, Malmo, Sweden.
TB/HIV Department, Ethiopian Public Health Institute, Addis Ababa, Ethiopia.
J Acquir Immune Defic Syndr. 2022 Apr 15;89(5):566-574. doi: 10.1097/QAI.0000000000002908.
To determine viral load (VL) nonsuppression (VLN) rates, HIV drug resistance (HIVDR) prevalence, and associated factors among female sex workers (FSWs) in Ethiopia.
A cross-sectional biobehavioral survey was conducted among FSWs in 11 cities in Ethiopia in 2014. Whole blood was collected, and HIVDR genotyping was performed. Logistic regression analysis was performed to identify factors associated with VLN and HIVDR.
Among 4900 participants, 1172 (23.9%) were HIV-positive and 1154 (98.5%) had a VL result. Participants were categorized into antiretroviral therapy (ART) (n = 239) and ART-naive (n = 915) groups based on self-report. From the 521 specimens (ART, 59; ART-naive, 462) with VL ≥1000 copies/mL, genotyping was successful for 420 (80.6%) and 92 (21.9%) had drug resistance mutations (DRMs). Pretreatment drug resistance (PDR) was detected in 16.5% (63/381) of the ART-naive participants. Nucleoside reverse transcriptase inhibitor (NRTI), non-NRTIs (NNRTIs), and dual-class DRMs were detected in 40 (10.5%), 55 (14.4%), and 35 (9.2%) of the participants, respectively. Among 239 participants on ART, 59 (24.7%) had VLN. Genotyping was successfully performed for 39 (66.1%). DRMs were detected in 29 (74.4%). All 29 had NNRTI, 23 (79.3%) had NRTI or dual-class DRMs. VLN was associated with age 35 years or older, CD4+ T-cell count <350 cells/mm3, and being forced into selling sex. PDR and acquired drug resistance were associated with CD4+ T-cell count <350 cells/mm3 (P < 0.001).
The high VLN and HIVDR rates among FSWs underscore the need for targeted interventions to improve ART access and virologic monitoring to maximize the benefit of ART and limit the spread of HIV and HIVDR.
确定埃塞俄比亚女性性工作者（FSW）中的病毒载量（VL）抑制失败（VLN）率、艾滋病毒耐药（HIVDR）流行率以及相关因素。
2014 年在埃塞俄比亚 11 个城市对 FSW 进行了一项横断面生物行为调查。采集全血，进行 HIVDR 基因分型。采用 logistic 回归分析确定与 VLN 和 HIVDR 相关的因素。
在 4900 名参与者中，1172 名（23.9%）HIV 阳性，1154 名（98.5%）有 VL 结果。根据自我报告，参与者被分为接受抗逆转录病毒治疗（ART）（n = 239）和未接受 ART（n = 915）两组。在 521 份（ART 59 份；ART 未接受者 462 份）VL≥1000 拷贝/ml 的标本中，420 份（80.6%）和 92 份（21.9%）的标本成功进行了耐药基因突变（DRMs）基因分型。在 915 名未接受 ART 的参与者中，检测到预处理耐药（PDR）的有 16.5%（63/381）。核苷逆转录酶抑制剂（NRTI）、非核苷逆转录酶抑制剂（NNRTIs）和双类耐药突变分别在 40（10.5%）、55（14.4%）和 35（9.2%）名参与者中检测到。在 239 名接受 ART 的参与者中，59 名（24.7%）有 VLN。成功对 39 名（66.1%）进行了基因分型。在 29 名（74.4%）中检测到 DRMs。所有 29 名都有 NNRTI，23 名（79.3%）有 NRTI 或双类耐药突变。VLN 与 35 岁或以上、CD4+T 细胞计数<350 个细胞/mm3 以及被迫卖淫有关。PDR 和获得性耐药与 CD4+T 细胞计数<350 个细胞/mm3 相关（P<0.001）。
FSW 中高 VLN 和 HIVDR 率强调需要采取有针对性的干预措施，以改善 ART 机会并加强病毒学监测，从而最大限度地提高 ART 的益处，限制 HIV 和 HIVDR 的传播。
