National Prevalence of Transmitted HIV Drug Resistance

in Swaziland in 2011

R. Suzanne Beard, Ph.D.

Abstract/poster: TUPDC0103

Background Assessed the national level of transmitted drug

resistance (TDR) in recently HIV-infected adults (18-49 yrs.) using samples collected from seroconverters and acutely HIV-infected persons enrolled between 2010-2011 in the Swaziland HIV Incidence Measurement Survey (SHIMS)

18,172 adults completed household-based counseling and rapid HIV testing 13 seronegative, NAT positive (acute) 11,232 HIV-negative individuals had repeat HIV testing

six months later, 145 seroconverted (SC)

151 out of 158 HIV-positive samples were available for HIVDR analysis

Abstract/poster: TUPDC0103

Genotyping was performed with 3 assays: sequencing based (in-house), multiplex allele-specific (MAS), and allele-specific real-time PCR (AS-PCR)

detection limits of minor mutations of 20%, 1.6-12.5% and 0.2-1.7% respectively

TDR mutations were determined by Calibrated Population Resistance tool using the 2009 WHO DR mutation listAbstract/poster: TUPDC0103

Resistance Profile by Assay for Patients With TDR

Specimen # category

In-house Result

MAS Result

AS-PCR Result

20* SC K103N21 SC V106A V106AV31 SC Y181C33 SC Y181C

48 SC M46I+

72 SC V106M85 SC Y181C101 SC V106M103 SC V106M, Y181C122 SC Y181C Y181C Y181C141 acute Y181C148 acute K103N K103N K103N, Y181C151 acute Y181C148 acute K65R

4 3 13NNRTI

2.13%NNRTI

2.13% 7.91%* positive by in-house but was not successfully sequenced

designed to detect any PI mutations

Total Number of Major DR Mutations

+ the MAS-DR is not designed to detect this PI mutation and AS-PCR is not

Prevelence of TDR

Center for Global Health

Division of Global HIV/AIDS

Conclusions These findings provide the first estimate of the

national prevalence of TDR, using samples from a nationally representative cohort of HIV seroconverters and acutely HIV-infected individuals

Using WHO definitions, the TDR level in Swaziland is: low (<5%) based on the sequencing-based in-

house or more sensitive MAS assay moderate (5-15%) based on the ultrasensitive

AS-PCR Further work needs to be done to determine the

clinical significance of low-frequency DR mutations

Surveillance of TDR in recently HIV-1-infected populations can inform treatment programs on the efficacy of current ART regimens available

Abstract/poster: TUPDC0103