For a study, researchers examined the prevalence of acquired HIV drug resistance (HIVDR) and the variables that contributed to it in patients receiving first-line antiretroviral treatment (ART). The cross-sectional research comprised 702 patients who had been on first-line ART for at least 6 months and had a viral load (VL) of 1000 copies/mL. VL testing was performed on blood plasma samples, and specimens with unsuppressed VL were genotyped to discover HIVDR-associated mutations. STATA/SE was used to analyze the data.

The median time on ART was 86.4 months (interquartile range [IQR], 44.8–130.2 months), with a median CD4 count of 311 cells/mm3 (IQR, 197–484 cells/mm3) at ART commencement. 378 (88.3%) of 414 (68.2%) samples with unsuppressed VL were genotyped. HIVDR mutations comprised 347 (90.4%) non-nucleoside reverse transcriptase inhibitor (NNRTI), 291 (75.5%) NRTI, and 13 (3.5%) protease inhibitor (PI) resistance-associated mutations. The most prevalent HIVDR mutations were K65R (22.7%), M184V (15.4%), and D67N (9.8%) for NRTIs, and K103N (34.4%) and Y181C/I/V/YC (7 percent) for NNRTIs. Current ART regimen of zidovudine + lamivudine + nevirapine (aOR, 3.333 [95% CI: 1.022–10.870]; P = 0.046) for NRTI resistance and current ART regimen of tenofovir + emtricitabine + nevirapine (aOR, 0.148 [95%CI: 0.028–0.779]; P = 0.025), zidovudin + lamivudine + efavirenz (aOR, 0.105 [95% CI: 0.016–0.693]; p = 0.020) and zidovudine + lamivudine + nevirapine (aOR, 0.259 [95% CI: 0.084–0.793]; P = 0.019) for NNRTI resistance. History of switching ART regimen was linked with NRTI resistance (aOR, 2.53 [95 % CI: 1.198–5.356]; P = 0.016) and NNRTI resistance (aOR, 3.23 [95% CI: 1.435–7.278], P = 0.005).

In patients who failed to repress VL, the prevalence of acquired HIV drug resistance (HIVDR) was significant, and it was linked to the current ART regimen and switching ART regimens. The findings of the study backed up current WHO guidelines that recommend switching patients on an NNRTI-based regimen based on a single viral load test. They also suggested that national HIV VL monitoring of patients on ART has prevented long-term treatment failure, which would have resulted in the accumulation of TAMs and potential loss of efficacy of all NRTI used in second-line ART as the backbone in combination with either dolutegravir or boosted PIs.

Reference:journals.sagepub.com/doi/full/10.1177/13596535221102690