Abstract
ObjectiveFemale sex workers (FSW) have increased risk of HIV infection. Antiretroviral treatment (ART) can improve HIV outcomes and prevent HIV transmission. We analyzed antiretroviral (ARV) drug use and HIV drug resistance among HIV-positive FSW in the Dominican Republic and Tanzania.MethodsPlasma samples collected at study entry with viral loads >1,000 copies/mL were tested for ARV drugs and HIV drug resistance. ARV drug testing was performed using a qualitative assay that detects 22 ARV drugs in five classes. HIV genotyping was performed using the ViroSeq HIV-1 Genotyping System. Phylogenetic analyses were performed to determine HIV subtype and assess transmission clusters.ResultsAmong 410 FSW, 144 (35.1%) had viral loads >1,000 copies/mL (DR: n = 50; Tanzania: n = 94). ARV drugs were detected in 36 (25.0%) of 144 samples. HIV genotyping results were obtained for 138 (95.8%) cases. No transmission clusters were observed in either country. HIV drug resistance was detected in 54 (39.1%) of 138 samples (31/35 [88.6%] with drugs detected; 23/103 [22.3%] without drugs detected); 29/138 (21.0%) had multi-class resistance (MCR). None with MCR had integrase strand transfer inhibitor resistance. In eight cases, one or more ARV drug was detected without corresponding resistance mutations; those women were at risk of acquiring additional drug resistance. Using multivariate logistic regression, resistance was associated with ARV drug detection (p<0.001), self-reported ART (full adherence [p = 0.034]; partial adherence [p<0.001]), and duration of HIV infection (p = 0.013).ConclusionsIn this cohort, many women were on ART, but were not virally suppressed. High levels of HIV drug resistance, including MCR, were observed. Resistance was associated with detection of ARV drugs, self-report of ART with full or partial adherence, and duration of HIV infection. These findings highlight the need for better HIV care among FSW to improve their health, reduce HIV drug resistance, and decrease risk of transmission to others.
Highlights
The HIV epidemic is a global public health crisis, with approximately 37.9 million people living with HIV and 1.7 million new infections per year [1]
Plasma samples collected at study entry with viral loads >1,000 copies/mL were tested for ARV drugs and HIV drug resistance
Resistance was associated with detection of ARV drugs, self-report of Antiretroviral treatment (ART) with full or partial adherence, and duration of HIV infection
Summary
The HIV epidemic is a global public health crisis, with approximately 37.9 million people living with HIV and 1.7 million new infections per year [1]. Female sex workers (FSW) are at higher risk of HIV infection compared to women in the general population, with an overall global prevalence of 10.4% [2,3,4]. This disparity has been documented in sub-Saharan Africa and the Caribbean, where HIV prevalence among FSW is 36.9% and 6.1% respectively, compared to 7.4% and 0.38% among the general population of cisgender women [2, 3]. Ineffective HIV care and treatment negatively impact viral suppression in the FSW population, increasing the risk of HIV transmission to others [4, 13, 14]
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