HIV Drug Resistance-associated Mutations Among Art-naïve Female Sex Workers in Nairobi, Kenya

Abstract

Background: HIV is a public health concern issue worldwide, especially with the emergence of HIV drug resistance (HIVDR). People with HIVDR are prone to treatment failure and have a higher chance of transmitting HIV than those with the wild type. There is a knowledge gap regarding HIVDR patterns amongst Female sex workers (FSWs) in Nairobi. Some FSWs are infected with strains bearing resistance mutations to recommended first-line Anti-retroviral therapy (ART). Methods: To evaluate HIV Drug Resistance-associated Mutations (DRMs) among ART-naive FSWs in Kenya, we characterized HIVDR on samples collected from 158 ART-naive FSWs between November 2020 and April 2021. Viral RNA was extracted from plasma and amplified by RT-PCR, then the Sanger sequencing technique was used to sequence the samples, and HIV DRMs associated with reverse transcriptase inhibitors and protease inhibitors were identified using the Stanford HIV database. Results: We successfully sequenced 64 of the 158 samples. The mean age and baseline CD4 counts were 36 (22–58) years and 369.2 (23– 1113) cells/mm3 respectively. Of the 64 samples genotyped, 22 (34.4%) had detectable DRMs. Major reverse transcriptase inhibitors mutations were observed in 32.8% (21/64) of the FSWs. The prevalence of nucleoside reverse transcriptase inhibitors DRMs was 6.3% (4/64), non-nucleoside reverse transcriptase inhibitors DRMs was 32.8% (21/64) and protease inhibitors DRMs was 4.7% (4/64). There were 3 FSWs (4.7%) with DRMs to both tenofovir and lamivudine and 14 (21.5%) with high-level resistance to efavirenz. A majority (17/22,77.3%) of the FSWs who had DRMs had CD4 counts below 500 cells/mm3. The predominant subtypes were A1 67.2% (43/64) and D 15.6% (10/64). Conclusion: There is a high prevalence of pretreatment drug resistance (PDR) among ART-naive FSWs. Drug resistance testing and surveillance may need to be implemented for the general population. We also recommend a nationwide PDR survey to investigate the causes of PDR, and effective measurements needed for efficient population-based interventions.