Retention in Care, Mortality, Loss-to-Follow-Up, and Viral Suppression among Antiretroviral Treatment-Naïve and Experienced Persons Participating in a Nationally Representative HIV Pre-Treatment Drug Resistance Survey in Mexico

Yanink Caro-Vega,Santiago Ávila-Ríos,Claudia García-Morales,Carlos Chivardi,Alicia Piñeirúa-Menendez,Eva A. Enns,Sandra Sosa-Rubí,Gustavo Reyes-Terán,Fernando Alarid-Escudero,Juan G. Sierra-Madero

doi:10.3390/pathogens10121569

Abstract

We describe associations of pretreatment drug resistance (PDR) with clinical outcomes such as remaining in care, loss to follow-up (LTFU), viral suppression, and death in Mexico, in real-life clinical settings. We analyzed clinical outcomes after a two-year follow up period in participants of a large 2017–2018 nationally representative PDR survey cross-referenced with information of the national ministry of health HIV database. Participants were stratified according to prior ART exposure and presence of efavirenz/nevirapine PDR. Using a Fine-Gray model, we evaluated virological suppression among resistant patients, in a context of competing risk with lost to follow-up and death. A total of 1823 participants were followed-up by a median of 1.88 years (Interquartile Range (IQR): 1.59–2.02): 20 (1%) were classified as experienced + resistant; 165 (9%) naïve + resistant; 211 (11%) experienced + non-resistant; and 1427 (78%) as naïve + non-resistant. Being ART-experienced was associated with a lower probability of remaining in care (adjusted Hazard Ratio(aHR) = 0.68, 0.53–0.86, for the non-resistant group and aHR = 0.37, 0.17–0.84, for the resistant group, compared to the naïve + non-resistant group). Heterosexual cisgender women compared to men who have sex with men [MSM], had a lower viral suppression (aHR = 0.84, 0.70–1.01, p = 0.06) ART-experienced persons with NNRTI-PDR showed the worst clinical outcomes. This group was enriched with women and persons with lower education and unemployed, which suggests higher levels of social vulnerability.

Highlights

Licensee MDPI, Basel, Switzerland.HIV pretreatment drug resistance (PDR), to non-nucleoside reverse transcriptase inhibitors (NNRTI) is associated with lower viral suppression (VS) in persons that initiate NNRTI-based antiretroviral treatment (ART) regimens [1,2]
Using a Fine-Gray model, we found that being ART-experienced was associated with a lower probability of remaining in care with viral suppression over time
The present study provides evidence that ART re-starters, as well as persons with pretreatment NNRTI resistance, in general have worse clinical outcomes than persons without previous exposure to ART and persons without NNRTI resistance in a cohort of Mexican individuals followed for two years

Summary

Introduction

HIV pretreatment drug resistance (PDR), to non-nucleoside reverse transcriptase inhibitors (NNRTI) is associated with lower viral suppression (VS) in persons that initiate NNRTI-based antiretroviral treatment (ART) regimens [1,2]. Solid evidence suggests that NNRTI PDR levels have been consistently increasing in low-/middle-income countries (LMICs) worldwide during the last decade [3], posing a significant threat for the achievement of UNAIDS 95–95–95 goals for ending the AIDS epidemic [4]. Exception to this trend, with recent studies showing increasing NNRTI PDR trends in three focal points of the HIV epidemic in the country [5]. A large nationally representative survey performed in Mexico in 2017–2018 showed a PDR level to NNRTI in all ART initiators of. (19.5–34.3%) in previously antiretroviral-exposed individuals that re-start ART [6,7]. Up until late 2019, Mexican HIV treatment guidelines recommended NNRTI-based first-line

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Results

Conclusion