Prevalence and associated factors with HIV-1 drug resistance mutations experienced in second line treatment of patients in Rwanda, 2012 -2022

Abstract

Background: Human Immunodeficiency infection drug resistance (HIVDR) is a challenge in the control of HIV/AIDS pandemic. The HIVDR is expected to emerge in population receiving antiretroviral. We targeted to calculate the prevalence and related factors of HIV-1 drug resistance mutations among PLHIV that received and resisted to second line treatment in Rwanda from January 2012 to December 2022.

Methods: A retrospective cross section study was conducted on PLHIV that failed second line regimen from January 2012 to December 2022. Data collection was based on data bank from patient files. Data collected were treatment duration, VL, CD4 count, ART regimen, drug resistance results (mutations), comorbidities, adherence, age, gender, education levels, marital status, residence, occupation and living situation. A logistic regression model was conducted to calculate crude odds and ratios and trend analysis of HIVDR mutations. A bivariate and multivariate logistic regression analysis were used to identify associated factors with HIVDR mutations among people living with HIV that received and failed to respond on second line HIV treatment.

Results: In total, data of 1903 participants were analyzed and the prevalence of HIV drug resistance mutation was found at 4.2%. Reverse Transcriptase Inhibitors (NRTI) mutation, M184V was most commonly occurring mutations at 42.5%. We found association between HIVDR mutations and being within business occupation (AOR: 4.6; 95% CI: 1.07– 19.97) and Jobless (AOR: 5.3; 95% CI: 1.34 – 20.9). We found also association between HIVDR mutations and having comorbidities (AOR: 6.4; 95% CI: 1.68 – 24.32). A positive association was also observed between HIVDR and poor adherence (AOR: 6.24; 95% CI: 2.7 – 14.13). Having high viral load (above 2000 HIV/microliter of blood) was also found as factors associated with HIVDR mutations among PLHIV (AOR: 3.03; 95% CI: 1.17 – 7.73). Having low CD4, being more than 5 years on second line treatment, taking Zidovudine + Lamivudine + Atazanavir/ritonavir (AZT+3TC+ATV/r) as second line ART (AOR: 5.34; were also found as associated factors with HIVDR mutations.

Conclusion: The prevalence of HIVDR mutations is 4.2% and was associated with poor adherence, comorbidities, low CD4 counts, high VL, ART duration and ART regimen