Drug resistance in HIV-positive adults during the initial year of antiretroviral treatment at Ethiopian health centers

Background. The increasing prevalence of antiretroviral drug resistance in Sub-Saharan Africa threatens the success of HIVprograms. We have characterized patterns of drug resistance mutations (DRMs) during the initial year of antiretroviral treatment (ART) in HIV-positive adults receiving care at Ethiopian health centers and investigated the impact of tuberculosis on DRMacquisition.Methods. Participants were identified from a cohort of ART-naive individuals aged ≥18 years, all of whom had been investigatedfor active tuberculosis at inclusion. Individuals with viral load (VL) data at 6 and/or 12 months after ART initiation were selectedfor this study. Genotypic testing was performed on samples with VLs ≥500 copies/mL obtained on these occasions and on pre-ARTsamples from those with detectable DRMs during ART. Logistic regression analysis was used to investigate the association betweenDRM acquisition and tuberculosis.Results. Among 621 included individuals (110 [17.5%] with concomitant tuberculosis), 101/621 (16.3%) had a VL ≥500 copies/mL at 6 and/or 12 months. DRMs were detected in 64/98 cases with successful genotyping (65.3%). DRMs were detected in 7/56(12.5%) pre-ART samples from these individuals. High pre-ART VL and low mid-upper arm circumference were associated withincreased risk of DRM acquisition, whereas no such association was found for concomitant tuberculosis.Conclusions. Among adults receiving health center–based ART in Ethiopia, most patients without virological suppressionduring the first year of ART had detectable DRM. Acquisition of DRM during this period was the dominant cause of antiretroviraldrug resistance in this setting. Tuberculosis did not increase the risk of DRM acquisition. (Less)