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Clinical
Original article
Sustained virological response and drug resistance among female sex workers living with HIV on antiretroviral therapy in Kampala, Uganda: a cross-sectional study
  1. Gertrude Namale1,
  2. Onesmus Kamacooko1,
  3. Daniel Bagiire1,
  4. Yunia Mayanja1,
  5. Andrew Abaasa1,
  6. William Kilembe2,
  7. Matt Price3,4,
  8. Deogratius Ssemwanga1,
  9. Sandra Lunkuse1,
  10. Maria Nanyonjo1,
  11. William Ssenyonga1,
  12. Philippe Mayaud1,5,
  13. Rob Newton1,6,
  14. Pontiano Kaleebu1,
  15. Janet Seeley1,5
  1. 1 MRC/UVRI and LSHTM Uganda Research Unit, Kampala, Uganda
  2. 2 Rwanda Zambia HIV Research Group, Emory University, Lusaka, Zambia
  3. 3 Medical Affairs, International AIDS Vaccine Initiative, New York City, New York, USA
  4. 4 University of California, San Francisco, California, USA
  5. 5 London School of Hygiene and Tropical Medicine, London, UK
  6. 6 University of York, York, UK
  1. Correspondence to Dr Gertrude Namale, MRC/UVRI and LSHTM Uganda Research Unit, Kampala 256, Uganda; gertrude.namale{at}mrcuganda.org

Abstract

Objectives We assessed the prevalence and risk factors associated with virological failure among female sex workers living with HIV on antiretroviral therapy (ART) in Kampala, Uganda.

Methods We conducted a cross-sectional study between January 2015 and December 2016 using routinely collected data at a research clinic providing services to women at high risk of STIs including HIV. Plasma samples were tested for viral load from HIV-seropositive women aged ≥18 years who had been on ART for at least 6 months and had received adherence counselling. Samples from women with virological failure (≥1000 copies/mL) were tested for HIV drug resistance by population-based sequencing. We used logistic regression to identify factors associated with virological failure.

Results Of 584 women, 432 (74%) with a mean age of 32 (SD 6.5) were assessed, and 38 (9%) were found to have virological failure. HIV resistance testing was available for 78% (28/38), of whom 82.1% (23/28) had at least one major drug resistance mutation (DRM), most frequently M184V (70%, 16/23) and K103N (65%, 15/23). In multivariable analysis, virological failure was associated with participant age 18–24 (adjusted OR (aOR)=5.3, 95% CI 1.6 to 17.9), self-reported ART non-adherence (aOR=2.6, 95% CI 1.2 to 5.8) and baseline CD4+ T-cell count ≤350 cells/mm3 (aOR=3.1, 95% CI 1.4 to 7.0).

Conclusions A relatively low prevalence of virological failure but high rate of DRM was found in this population at high risk of transmission. Younger age, self-reported ART non-adherence and low CD4+ T-cell count on ART initiation were associated with increased risk of virological failure.

  • HIV
  • female sex workers
  • virological suppression
  • virological failure
  • antiretroviral therapy (art)
  • drug resistance mutation

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/sextrans-2018-053854

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    Footnotes

    • Handling editor Jackie A Cassell

    • Contributors GN conceived and designed the study. AA, OK and DB performed the statistical analysis. GN wrote the manuscript. PK, MP, WK, AA, JS, RN, YM, DS, DB, OK, WS, SL and MN oversaw the overall execution of the manuscript writing. MP, WK, AA, JS, PM and RN oversaw the critical revisions of the manuscript. All authors read and approved the final manuscript.

    • Funding We would like to thank the UK Medical Research Council (MRC) and the UK Department for International Development (DFID) under the MRC/DFID Concordat agreement, which is also part of the EDCTP2 programme supported by the European Union, for funding. The clinic services and ART programme were supported by PEPFAR. This work was partially funded by IAVI with the generous support of USAID and other donors; a full list of IAVI donors is available at www.iavi.org. The content of this manuscript is the responsibility of the authors and does not necessarily reflect the views of USAID or the US Government. We also thank the University of California, San Francisco’s International Traineeships in AIDS Prevention Studies (ITAPS), US NIMH, R25MH064712, for support.

    • Competing interests None declared.

    • Patient consent for publication Obtained.

    • Ethics approval Ethical approval was obtained from the Uganda Virus Research Institute Research and Ethics Committee and the Uganda National Council for Science and Technology (reference number HS364). Written informed consent was obtained from participants and confidentiality was maintained throughout the study period.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement The data collected in this study are suitable for sharing and the procedures for accessing it are contained in the data sharing policy accessible from the Medical Research Council website (https://www.mrcuganda.org/publications/data-sharing-policy).