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Antiretroviral Drug Use and HIV Drug Resistance Among Young Women in Rural South Africa

HPTN 068

Zhang, Yinfeng, PhD*; Sivay, Mariya V., PhD*; Hudelson, Sarah E., BS*; Clarke, William, PhD*; Breaud, Autumn, MS*; Wang, Jing, MS, MA; Piwowar-Manning, Estelle, BS, MT (ASCP)*; Agyei, Yaw, MPH, BS, MT (ASCP)*; Fogel, Jessica M., PhD*; Hamilton, Erica L., MPH; Selin, Amanda, MHS§; MacPhail, Catherine, PhD║,¶; Kahn, Kathleen, MD, PhD; Gómez-Olivé, Francesc Xavier, MD, PhD; Hughes, James P., PhD#; Pettifor, Audrey, PhD, MPH¶,**; Eshleman, Susan H., MD, PhD*

JAIDS Journal of Acquired Immune Deficiency Syndromes: November 1, 2018 - Volume 79 - Issue 3 - p 315–322
doi: 10.1097/QAI.0000000000001793

Background: Antiretroviral (ARV) drugs are used for HIV treatment and prevention. We analyzed ARV drug use and HIV drug resistance in a cohort of young women in rural South Africa enrolled in the HIV Prevention Trials Network (HPTN) 068 study, which evaluated the use of a cash transfer conditional on school attendance to reduce HIV incidence.

Methods: ARV drug testing was performed using plasma samples from 2526 young women. This included 2526 enrollment samples (80 HIV-infected and 2446 HIV-uninfected) and 162 seroconversion samples (first HIV-positive study visit). Testing was performed using a qualitative assay that detects 20 ARV drugs from 5 drug classes. HIV drug resistance testing was performed with the ViroSeq HIV-1 Genotyping System for samples that had HIV viral loads ≥400 copies per milliliter.

Results: At enrollment, ARV drugs were detected in 10 (12.5%) of 80 HIV-infected young women. None of 2446 HIV-uninfected young women had ARV drugs detected at enrollment. ARV drugs were also detected in 16 (9.9%) of 162 seroconverters. At enrollment, 9 (13.4%) of 67 young women with genotyping results had HIV drug resistance; resistance was also detected in 9 (6.9%) of 131 seroconverters with genotyping results.

Conclusions: Most of the HIV-infected young women in this cohort from rural South Africa were not taking ARV drugs, suggesting they were unaware of their HIV status or were not in care. HIV drug resistance was detected in young women with both prevalent and new HIV infection.

*Department of Pathology, Johns Hopkins University School of Medicine, Baltimore, MD

Statistical Center for HIV/AIDS Research & Prevention (SCHARP), Seattle, WA

Science Facilitation Department, FHI 360, Durham, NC

§Carolina Population Center, University of North Carolina at Chapel Hill, Chapel Hill, NC

School of Health and Society, University of Wollongong, Australia;

MRC/Wits Rural Public Health and Health Transitions Research Unit (Agincourt), School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa;

#Department of Biostatistics, University of Washington, Seattle, WA

**Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC.

Correspondence to: Susan H. Eshleman, MD, PhD, Department of Pathology, The Johns Hopkins Medical Institutions, Ross Building, Room 646, 720 Rutland Avenue, Baltimore, MD 21205 (e-mail:

Supported by the National Institute of Allergy and Infectious Diseases (NIAID) and the National Institute of Mental Health (NIMH) of the National Institutes of Health (NIH); UM1-AI068613; UM1-AI068617; UM1-AI068619); NIMH R01-MH087118; and the Carolina Population Center (NIH Center grant P2C-HD050924).

The authors have no funding or conflicts of interest to disclose, with the following exceptions: S.H.E has collaborated on research studies with investigators from Abbott Laboratories; Abbott Laboratories has provided reagents for collaborative research studies.

Y.Z. and M.V.S. contributed equally to this work.

All authors contributed to manuscript preparation. Y.Z.: analyzed data; drafted the manuscript; M.V.S.: performed HIV genotyping; analyzed data; S.E.H.: performed HIV genotyping; analyzed data; W.C.: responsible for antiretroviral drug testing; A.B.: performed antiretroviral drug testing; J.W.: data analyst for HPTN 068; E.P.-M.: HPTN Laboratory Center QAQC representative for HPTN 068; Y.A.: HPTN International QAQC coordinator for HPTN 068; J.M.F.: analyzed data; E.L.H.: HPTN Leadership and Operations Center Representative for HPTN 068; A.S.: research associate for HPTN 068; C.M.: investigator for HPTN 068; K.K.: site principal investigator for HPTN 068; F.X.G.-O.: investigator of record for HPTN 068; J.P.H.: Statistician for HPTN 068; A.P.: protocol chair for HPTN 068; and S.H.E.: designed the study; analyzed data; and drafted the manuscript.

This is an open-access article distributed under the terms of the Creative Commons Attribution-Non Commercial License 4.0 (CCBY-NC), where it is permissible to download, share, remix, transform, and buildup the work provided it is properly cited. The work cannot be used commercially without permission from the journal.

Received February 02, 2018

Accepted May 21, 2018

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