ABSTRACT
Background
HIV drug resistance increases mortality and morbidity and antiretroviral therapy (ART) costs. We describe Paraguay's first nationally representative survey on pretreatment drug resistance (PDR) conducted among persons who initiated or re-initiated ART in 2019.
Material and Methods
We conducted a cross-sectional survey of antiretroviral drug resistance in Paraguay during 2019. Participants were sampled at four comprehensive care clinics where 90% of patients with HIV in Paraguay initiate ART. Patients included were adults ≥18 years old who initiated first-line ART or re-initiated the same first-line ART regimen after ≥3 months of discontinuation.
Results
Of 208 patients, 93.8% had no prior ART exposure, 3.8% re-initiated the same regimen, 2.4% had unknown prior ART exposure; 31.3% had a CD4 count <200 cells/µL. Mutations associated with resistance were present in 15.4% of patients. Mutations associated with resistance to non-nu cleoside reverse transcriptase inhibitors (NNRTI) were present in 13.0% of patients, nucleoside reverse transcriptase inhibitors in 4.3%, and integrase inhibitors in 3.4%. Mutations associated with resistance to tenofovir were present in 1.0% of patients and emtricitabine/lamivudine in 1.4%.
Conclusions
Nearly one in six patients had PDR in Paraguay's first nationally representative sample. High NNRTI PDR prevalence underscores the need to accelerate the transition to dolutegravir-based first-line ART. Low PDR prevalence to tenofovir and emtricitabine is reassuring as these antiretrovirals are part of the WHO-recommended oral pre-exposure prophylaxis (PrEP) regimen. The high proportion of individuals initiating ART at a late disease stage highlights the need to improve treatment linkage strategies and implement WHO rapid ART initiation recommendations.
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