Prevalence of Transmitted HIV-1 Drug Resistance among Young Adults Attending HIV Counselling and Testing Clinics in Kigali, Rwanda

Mwumvaneza Mutagoma, Jean d'Amour Ndahimana, Eugenie Kayirangwa, Anicet G Dahourou, Helen Balisanga, Joshua R DeVos, David McAlister, Chunfu Yang, Silvia Bertagnolio, David J Riedel, Sabin Nsanzimana

Scaling up antiretroviral therapy (ART) in resource-limited settings has raised concerns of emerging HIV drug resistance (DR) and its transmission to newly infected individuals. To assess the prevalence of transmitted drug resistance (TDR) in recently HIV-infected individuals, a WHO TDR threshold survey was conducted among young adults in Kigali, Rwanda. Between May and July 2011, HIV subtype and genotyping were performed on dried blood spots (DBS) prepared from blood specimens collected from newly HIV-diagnosed and ART-naïve individuals aged 15 to 21 years in eight HIV voluntary counselling and testing (VCT) sites in Kigali. Fifty-seven of the 68 DBS collected from eligible participants were successfully amplified. The median age of participants was 20 years, and 86% were female. Most participants (96%) were infected with subtype A1 virus. Two participants (4%) had the K103N non-nucleoside reverse transcriptase inhibitor (NNRTI) mutation, and one (2%) had the M46L protease inhibitor (PI) mutation. The TDR prevalence was 3.5% (95% CI 0.4, 12.1) for NNRTI and 1.8% (95% CI 0.0, 9.4) for PI. The prevalence of HIV TDR in VCT attendees in Kigali was characterized as low (<5%) for all drug classes according to the WHO HIV drug resistance threshold survey methodology. Despite a decade of widespread ART in Rwanda, TDR prevalence remains low, and so the current first-line ART regimens should continue to be effective. However, as scale-up of ART continues, frequent HIVDR surveillance is needed to monitor the effectiveness of available ART regimens at the population level.