Abstract
Rilpivirine (RPV) and Etravirine (ETR) are second-generation non-nucleoside reverse transcriptase inhibitors (NNRTIs) that are not used for HIV-1 treatment in Kenya. In this cross-sectional study, we sequenced and analyzed the reverse transcriptase and pol regions of HIV-1 genome from 140 HIV infected individuals from Busia County Referral Hospital, Western Kenya, who were on anti-HIV treatment with confirmed virologic failure. All the participants were on first-generation NRTI’s and NNRTI’s for more than 12 months at the time of the study. Briefly, HIV RNA was extracted from plasma samples and sequenced to analyze for the presence of HIV-1 drug resistance mutations. The study findings showed that approximately 46% of the population had genotypic drug resistance against both Etravirine and Rilpivirine which were classified as ranging from potentially low level resistance to high level resistance despite being exposed to first-generation NNRTIs only. The study thus reveals that cross-resistance was demonstrated between primary and secondary NNRTI drugs. The development of cross resistance for RPV and ETR in patients on EFV and NVP poses a challenge in the use of these drugs as second generation NNRTI drugs. Key words: Non-nucleoside reverse transcriptase inhibitors (NNRTIs), NRTIs, Kenya, cross-resistance, Etravirine (ETR), Rilpivirine (RPV), HIV-1.
Highlights
IntroductionAs of 2019, 38 million people were estimated to be living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) globally
This study aimed at evaluating the prevalence of resistance against second-generation non-nucleoside reverse transcriptase inhibitors (ETR and RPV) in patients who were on first-generation NNRTIs (EFV and NVP) for more than 12 months in Western Kenya
All patients were on first-generation NRTI and NNRTI regimens at the hospital’s HIV comprehensive care center (CCC) which provides HIV treatment and care services to patients from Kenya’s Western region
Summary
As of 2019, 38 million people were estimated to be living with human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) globally Kenya on the other hand, is among the top five countries with the highest HIV burden globally (Kimanga et al, 2014) and has made considerable progress in the fight against HIV/AIDS over the years (Kenya AIDS Response Progress Report, 2016; Mwau et al, 2018; Joint United Nations Programme on HIV/AIDS, 2018b). By the end of 2018, an estimated 1.6 million people were living with HIV, 46,000 people being newly infected with HIV, and 26,000 dying from AIDS-related in Kenya (Joint United Nations Programme on HIV/AIDS, 2018b). 1.5 million people between 15-49 years were living with HIV/AIDS in Kenya by the end of 2017 (National AIDS Control Council, 2018). There was a significant decline in the total number of HIV/AIDS orphans from 959,334 children in 2010 to 661,119 in 2015 (National AIDS Control Council, 2018)
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