For a study, researchers examined the prevalence of acquired HIV drug resistance (HIVDR) and the variables that contribute to it in patients receiving first-line antiretroviral treatment (ART) in Rwanda. The cross-sectional research comprised 702 patients who had been on first-line ART for at least six months and had a viral load (VL) of ≥1,000 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. About 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. For NRTIs, the most prevalent HIVDR mutations were K65R (22.7%), M184V (15.4%), and D67N (9.8%), whereas for NNRTIs, the most common were K103N (34.4%) and Y181C/I/V/YC (7%). For NRTI resistance, current ART regimens of zidovudine + lamivudine + nevirapine (aOR, 3.333 [95% CI: 1.022-10.870]; P=0.046), tenofovir + emtricitabine + nevirapine (aOR, 0.148 [95% CI: 0.028-0.779]; P=0.025), zidovudine + 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. 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) were related with a history of ever altering ART regimen.

Patients who failed to unsuppressed VL had a significant incidence of acquired HIV drug resistance (HIVDR), which was linked to both their current ART regimen and whether they had previously switched ART regimens. The results of the study support the current WHO recommendations that patients on an NNRTI-based regimen be switched based on a single viral load test. They also suggest that national HIV VL monitoring of ART patients has prevented long-term treatment failure that would have led to the accumulation of TAMs and potential loss of efficacy of all NRTI used in second-line ART as the foundation in combination with either raltegravir or boosted PIs.