Abstract:
Background: The Government of Kenya started offering ART in the public sector since 2003.
Despite the dramatic reduction in AIDS related morbidity and mortality, the emergence and spread of
drug resistance (DR) threatens to negatively impact on treatment regimens and compromise efforts
to control the epidemic. Therefore, there is a need for information on the situation of DR Mutations
(DRMS) and their implications on treatment.
Objectives: To evaluate DRMS and their implications on treatment in HIV infected individuals
attending Moi Teaching and Referral Hospital (MTRH) clinics.
Method: In 2009, we consecutively collected plasma samples from two groups of HIV infected
individuals, antiretroviral (ARV) naive and ARV experienced for more than 12 months and failing
therapy according to world health organisation (WHO) guidelines. We performed genotypic DR
using well established in-house Sanger sequencing methods. We then followed up the patients and
compared the DRMS in relation to their drug regimens at the time of sample collection and16 months
later.
Results: We successfully extracted and sequenced 75 samples. Median age was 36.7 years.
Out of 41 drug naive individuals only 3 had DRMS. Out of the 34 ARV experienced, 29 had DRMS to
nucleoside reverse transcriptase inhibitor (NRTI), and 31 to non NRTI (NNRTI). After 16 months from
sample collection date, 20/31(64%) ARV experienced patients with DRMS had not been changed
therapy and only 5/20(25%) were susceptible to primary ARV while 12/14 changed were susceptible
to new ARV.
Conclusion: The information obtained in our study can serve as an indicator of ARV program
efficiency in patients still on treatment, those who are to start treatment and those who are to be
changed therapy due to failure. DR testing would be necessary before initiating and /or changing ART
in order to achieve optimal clinical outcome.