Abstract
BackgroundPersons who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. We evaluated HIV drug resistance in PWID in a randomized clinical trial (HPTN 074). The study intervention included ART at any CD4 cell count with enhanced support for ART and substance use treatment.MethodsHPTN 074 enrolled HIV-infected PWID (index participants) with viral loads ≥1,000 copies/mL and their HIV-uninfected injection-network partners in Indonesia, Ukraine, and Vietnam; the study limited enrollment of people who reported being on ART. HIV drug resistance testing and antiretroviral (ARV) drug testing were performed using samples collected from index participants at study enrollment.ResultsFifty-four (12.0%) of 449 participants had HIV drug resistance; 29 (53.7%) of the 54 participants had multi-class resistance. Prevalence of resistance varied by study site and was associated with self-report of prior or current ART, detection of ARV drugs, and a history of incarceration. Resistance was detected in 10 (5.6%) of 177 newly diagnosed participants. Participants with resistance at enrollment were less likely to be virally suppressed after 52 weeks of follow-up, independent of study arm.ConclusionsIn HPTN 074, many of the enrolled index participants had HIV drug resistance and more than half of those had multi-class resistance. Some newly-diagnosed participants had resistance, suggesting that they may have been infected with drug-resistant HIV strains. Behavioral and geographic factors were associated with baseline resistance. Baseline resistance was associated with reduced viral suppression during study follow-up. These findings indicate the need for enhanced HIV care in this high-risk population to achieve sustained viral suppression on ART.
Highlights
Injection of illicit drugs carries a high risk of HIV transmission due to sharing of contaminated equipment
These findings indicate the need for enhanced HIV care in this high-risk population to achieve sustained viral suppression on antiretroviral therapy (ART)
ART has been systematically withheld in some populations of Persons who inject drugs (PWID) [6,7,8] due to concerns that PWID may be more likely to develop HIV drug resistance [9, 10] and that drug-resistant HIV will spread through drug-injection practices [10]
Summary
Injection of illicit drugs carries a high risk of HIV transmission due to sharing of contaminated equipment. High HIV incidence and prevalence among persons who inject drugs (PWID) have been reported in many regions [1, 2]. Most PWID have limited access to HIV testing, antiretroviral therapy (ART), and other health services due to social stigmatization, criminalization of injection drug use, and other factors [3,4,5]. PWID often have unstable lives and may be less likely to adhere to ART, which would promote development of resistance [11, 12]. In some settings, PWID had similar rates of ART adherence and resistance to those who do not inject drugs [10, 13]. Persons who inject drugs (PWID) have high HIV incidence and prevalence, and may have limited access to antiretroviral therapy (ART) in some settings. The study intervention included ART at any CD4 cell count with enhanced support for ART and substance use treatment
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