Drug resistance mutations among people living with HIV and ART failure in Bangladesh: a cross-sectional study

IF 6.2 Q1 HEALTH CARE SCIENCES & SERVICES

The Lancet regional health. Southeast Asia Pub Date : 2025-07-04 DOI:10.1016/j.lansea.2025.100629

Sezanur Rahman , Md Safiullah Sarker , Md Mobarok Hossain , Md Abir Hossain , Mohammad Fakhruddin , Rubel Howlader , Golam Sarwar , Sharful Islam Khan , Mustafizur Rahman

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引用次数: 0

Abstract

Background

While maintaining a low HIV prevalence among the general population, Bangladesh is among the few countries in the Asia–Pacific region where the incidence of people living with HIV (PLWH) continues to increase. The National Anti-Retroviral Therapy Program still relies on a ‘Test and Treat’ strategy and faces challenges in treating drug-resistant HIV. This study aims to assess the HIV viral load and drug resistance mutations among key populations (KPs) under anti-retroviral therapy (ART) in Bangladesh.

Methods

A total of 110 KPs from 20 drop-in-centers across 11 districts in Bangladesh were enrolled from March 2019 to November 2020 for viral load (VL) testing using Xpert® HIV-1 Viral Load kits. Samples with high VL (≥1000 copies/mL) underwent pol gene sequencing to identify drug resistance mutations.

Findings

Most of the participants were men who have sex with men (MSM, 49.1%) followed by men sex workers (MSW, 34.5%), and transgender women (TGW, 13.6%). The median age of the participants was 28 years (IQR: 24–35) and 80% of them were from the capital city, Dhaka. The median time for ART was 11.5 months (IQR: 4.5–29.1), where 15 participants were naïve to ART. Overall, high VL was observed in 23.8%, and virologic failure was in 17.9% among PLWH who were treated for >30 days. HIV-1 subtype C was predominant (43.8%), followed by A1 (25%), CRF01_AE (25%), and CRF02_AG (6.2%). Seven participants showed resistance against Efavirenz, the common drug received from ART centres, and three of them were additionally resistant against Tenofovir Disoproxil Fumarate. Other drugs supplied by ART centres were also found resistant for participants; i.e. 6 against Emtricitabine, 6 against Lamivudine, and 1 against Etravirine. The spatial distribution indicated HIV transmission occurred within and between KPs and drop-in-centers. Additionally, samples that received different ART also clustered together.

Interpretation

Evidence suggests that KPs are at a higher risk of virologic failure in Bangladesh, emphasizing the need for routine VL and drug resistance mutation tests as part of the national ART program. This study also advocates for exploring barriers to ART adherence and implementing personalized ART strategies in national ART programs.

Funding

The Global Fund.

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孟加拉国艾滋病毒感染者的耐药性突变和抗逆转录病毒治疗失败：一项横断面研究

虽然孟加拉国在一般人群中保持着较低的艾滋病毒流行率，但它是亚太地区艾滋病毒感染者（PLWH）发病率持续上升的少数几个国家之一。国家抗逆转录病毒治疗方案仍然依靠“检测和治疗”战略，在治疗耐药艾滋病毒方面面临挑战。本研究旨在评估孟加拉国接受抗逆转录病毒治疗（ART）的关键人群（KPs）的HIV病毒载量和耐药性突变。方法2019年3月至2020年11月，在孟加拉国11个地区的20个临时中心招募了110名儿童，使用Xpert®HIV-1病毒载量试剂盒进行病毒载量（VL）检测。高VL（≥1000拷贝/mL）的样品进行pol基因测序以鉴定耐药突变。研究结果大多数参与者是男男性行为者（MSM, 49.1%），其次是男性性工作者（MSW, 34.5%）和变性女性（TGW, 13.6%）。参与者的中位年龄为28岁（IQR: 24-35），其中80%来自首都达卡。抗逆转录病毒治疗的中位时间为11.5个月（IQR: 4.5-29.1），其中15名参与者接受了抗逆转录病毒治疗naïve。总体而言，在治疗30天的PLWH中，高VL发生率为23.8%，病毒学失败发生率为17.9%。HIV-1亚型C占多数（43.8%），其次是A1（25%）、CRF01_AE（25%）和CRF02_AG（6.2%）。7名参与者对抗逆转录病毒治疗中心接受的常用药物依非韦伦（Efavirenz）有耐药性，其中3人对富马酸替诺福韦二氧吡酯（Tenofovir Disoproxil Fumarate）也有耐药性。抗逆转录病毒治疗中心提供的其他药物也发现对参与者具有耐药性；即6对恩曲他滨，6对拉米夫定，1对曲曲维林。空间分布表明艾滋病毒传播发生在幼儿园和收容中心内部和中心之间。此外，接受不同抗逆转录病毒治疗的样本也聚集在一起。证据表明，在孟加拉国，KPs有更高的病毒学失败风险，这强调需要将常规VL和耐药突变检测作为国家抗逆转录病毒治疗规划的一部分。本研究还提倡探索抗逆转录病毒治疗依从性的障碍，并在国家抗逆转录病毒治疗计划中实施个性化的抗逆转录病毒治疗策略。资助全球基金。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

The Lancet regional health. Southeast Asia

CiteScore

2.20

自引率

0.00%

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