Magister Public Health - MPH / Background: Antiretroviral therapy (ART) was rolled out in South Africa in the public sector
in 2004 and the treatment coverage has increased over the years to 56% in 2016. The increased
treatment coverage has the potential to increase the level of HIV drug resistance. Drug
resistance presents a major challenge to the management of HIV infection through
antiretroviral therapy at the population level. The aim of this study was to determine the impact
of the public sector antiretroviral therapy rollout on the prevalence of HIV drug resistance in
South Africa and the factors associated with drug resistance.
Methodology: A cross-sectional analytical study was used to determine the prevalence of drug
resistance before and after ART rollout. The study population was HIV infected South Africans
(infected between 1996 and 2011) who were not on antiretroviral therapy. The study sample
was therapy naïve HIV infected South Africans who participated in published studies
conducted between 1996 and 2011. HIV DNA sequences and associated data (participants’
age, gender, geographic location and estimated year of HIV infection) were accessed through
the Los Alamos HIV Database. The database contains all HIV DNA sequences and associated
data from all published studies and the data was freely accessible. A descriptive analysis was
carried out on the data to determine characteristics of the study sample. Drug resistance
mutations were detected using Calibrated Population Resistance Program on the Stanford
University HIV Drug Resistance database. The output from the Calibrated Population
Resistance Program analysis were used to determine the prevalence of drug resistance
mutations.
Results: There were 1701 DNA sequences obtained from the Los Alamos HIV Database for
the three gene regions targeted by ART (reverse transcriptase, protease and integrase). Of these,
604 (35,5%) were for reverse transcriptase, 794 (46,7%) were for protease and 303 (17,8%)
were for integrase. There was overrepresentation of DNA sequences from female participants
(91%). There was no significant difference in the prevalence of drug resistance mutations
between 1996-2004 (before ART rollout) and 2005-2011 (after ART rollout) in all the drug
classes. There was also no association between drug resistance and age as well as gender.
Conclusion: The data from this study suggest that the public sector rollout of ART did not
result in an increase in the prevalence of drug resistance mutations in therapy naïve HIVinfected
South Africans. There is need for further studies, which have a wider coverage of the
South African population.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:uwc/oai:etd.uwc.ac.za:11394/6699 |
| Date | January 2018 |
| Creators | Chopera, Denis Rutendo |
| Contributors | Knight, Lucia |
| Publisher | University of the Western Cape |
| Source Sets | South African National ETD Portal |
| Language | English |
| Detected Language | English |
| Rights | University of the Western Cape |
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