| dc.description.abstract | The introduction of antiretroviral therapy (ART) has resulted in improved treatment outcome and survival rate in human immunodeficiency virus (HIV) infected patients but the success of these drug regimens is challenged by the emergence of drug resistance-associated mutations. There is a public health concern on the widespread of HIV-1 treatment failure in Kenya. This drug failure may be attributed to increase in antiretroviral resistance mutations which may be
caused by a particular group of people who could be injecting drug users (IDUs). Risk
behaviors and lifestyle of this key population may make them non-adherent the therapeutic regimens leading to their exposure to suboptimal drug levels with possible emergence of drug resistance de novo. The association between risk behaviors and antiretroviral (ARV) non-adherence or risk behaviors and drug resistance mutations is not yet fully understood. Drug resistance testing and monitoring of HIV subtypes could
improve treatment outcome in infected individuals but the data is scanty in Kenya. The information obtained in this study was significant in guiding policy on the management of HIV drug resistance and testing before prescription or ART change so as not to compromise their efficacy. This was to reduce deaths occasioned by drug failure due to HIV resistance associated-mutations. This study was aimed at determining risk behaviors associated with antiretroviral non-adherence and HIV-1 drug resistance mutations among IDUs in Malindi Sub- County. This was a cross-sectional study design involving consenting IDUs who were above 18 years. Snowball sampling technique was used for the
recruitment 200 IDUs using structured questionnaire to collect socio-demographic
data and HIV behavioral risk factors. About 5 ml of whole blood was drawn from each
participant. Blood was separated into plasma and transported to the Kenya Medical Research Institute (KEMRI)-Nairobi under cold chain. The plasma was used for serological HIV testing using colloidal gold and HIV-1 mutation genotyping using nested polymerase chain reaction (PCR). Data analysis was achieved by use of both descriptive and inferential statistics. Behavioral risk factors were analyzed using descriptive statistics; cross tabulation. Relationships between risk behaviors and ART non-adherence, HIV-1 subtypes, HIV drug resistance were determined using Chi-square (χ2) tests and multiple logistic regressions was used to test the strengths of the relationships. All tests of significance were computed at α =0.05. The data analysis was carried out in STATA software version 13.0 (STATA Corp. LP, College Station, TX, USA). Non-adherence to ART was significantly associated with duration of drug use (OR 6.73, 95%Cl; 1.93-23.0; P value 0.003), IDU/CSW (OR 6.04, 95%Cl; 3.6510.0;P value 0.0001), needle sharing (OR 2.96, 95%Cl; 1.60-5.46; P value 0.0001) and
commercial sex work (OR 2.16, 95%Cl; 1.40-4.81; P value 0.0001). Being in prison was
strongly associated with stopping of ARTs, (OR2.85, 95%Cl; 1.40-5.84; P value 0.004).The proportion of drug resistance mutations were as follows: A1 12(52.2%) A2 1(4.3%) B 0(0.0%), C5(21.7%) and D 5(21.7%). There is high likelihood of getting HIV-1drug resistance mutations when one is infected with HIV sub-type A1 strain. Stopping ART use was strongly associated with the development of HIV drug resistance mutations among the injecting drug users (P =0.004; OR7.33, 95%Cl; 1.69-31.81). This study reveals that risk behaviors and lifestyle are associated with ART non-adherence among IDUs. Consequently, health education should focus on behavior and lifestyle change to avert potential drug resistance that will go beyond IDUs. There were drug resistance mutations across HIV-1 subtypes. With drug resistance across all the HIV-subtypes, there is a need to enhance the surveillance and more behavioral studies as IDUs may act as source of drug resistance to the general population. Since these findings established
association between stopping ART use and the development of HIV-1 drug resistance
mutations, it is advisable that close monitoring should be done to the IDUs who are enrolled on ART as the stopping of ART could lead to HIV drug resistance. More rehabilitation centers should therefore be built for regular follow-up to ensure the achievement of this so as to reduce health risks and social harm. | en_US |