Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa.
Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa.
Viruses. 2024 Oct 19;16(10):1634. doi: 10.3390/v16101634.
HIV-1 drug resistance (HIVDR) impedes treatment and control of HIV-1, especially in high-prevalence settings such as KwaZulu-Natal (KZN) province, South Africa. This study merged routine HIV-1 genotypic resistance test (GRT) data with Geographic Information Systems coordinates to assess patterns and geographic distribution of HIVDR in KZN, among ART-experienced adults with virological failure. We curated 3133 GRT records generated between 1 January 2018 and 30 June 2022, which includes the early phase of dolutegravir (DTG) rollout, of which 2735 (87.30%) had HIVDR. Of the 2735, major protease, nucleoside, and non-nucleoside reverse transcriptase inhibitor mutations were detected in 41.24%, 84.97% and 88.08% of GRTs, respectively. Additional genotyping of HIV-1 for 41/3133 (1.31%) GRTs showed that 17/41 (41.46%) had integrase strand transfer inhibitor resistance. Notably, of 26 patients on DTG with genotyping, 9 (34.62%) had DTG-associated resistance mutations. Dual- or triple-class resistance was observed in four of every five GRTs. The odds of HIVDR increased significantly with age, with ≥60 years having 5 times higher odds of HIVDR compared to 18-29 years ( = 0.001). We identified geospatial differences in the burden of HIVDR, providing proof of concept that this could be used for data-driven public health decision making. Ongoing real-time HIVDR surveillance is essential for evaluating the outcomes of the updated South African HIV treatment programme.
HIV-1 耐药性（HIVDR）阻碍了 HIV-1 的治疗和控制，尤其是在南非夸祖鲁-纳塔尔省（KZN）等高发地区。本研究将常规 HIV-1 基因型耐药性检测（GRT）数据与地理信息系统坐标相结合，评估了 KZN 地区接受过抗逆转录病毒治疗（ART）且病毒学失败的成年患者中 HIVDR 的模式和地理分布。我们整理了 2018 年 1 月 1 日至 2022 年 6 月 30 日期间生成的 3133 份 GRT 记录，其中包括多拉韦林（DTG）推出的早期阶段，其中 2735 份（87.30%）存在 HIVDR。在这 2735 份记录中，主要蛋白酶、核苷和非核苷逆转录酶抑制剂突变分别在 41.24%、84.97%和 88.08%的 GRT 中被检测到。对 3133 份 GRT 中的 41 份进行 HIV-1 基因分型检测显示，17 份（41.46%）存在整合酶链转移抑制剂耐药性。值得注意的是，在 26 名接受 DTG 治疗且进行基因分型的患者中，有 9 名（34.62%）存在与 DTG 相关的耐药突变。每五份 GRT 中就有四份存在双重或三重耐药。随着年龄的增长，HIVDR 的发生几率显著增加，≥60 岁患者 HIVDR 的发生几率是 18-29 岁患者的 5 倍（ = 0.001）。我们发现了 HIVDR 负担的地理空间差异，为这一概念提供了证据，即这可以用于基于数据的公共卫生决策。实时进行 HIVDR 监测对于评估南非更新后的 HIV 治疗方案的结果至关重要。
