Antiretroviral resistance among HIV-1 patients on first-line therapy attending a comprehensive care clinic in Kenyatta National Hospital, Kenya: a retrospective analysis.

INTRODUCTION: Antiretroviral therapy plays a major role in reducing the impact of Human Immunodeficiency Virus/Acquired Immune Disease Syndrome, especially in resource-limited settings. However, without proper infrastructure, it has resulted in emergence of drug resistance mutations in infected populations. To determine drug resistance mutations among patients attending a comprehensive care facility in Nairobi, 65 blood samples were successfully sequenced. METHODS: Whole blood samples were also tested for CD4+T-cell count and plasma HIV-1 RNA Viral load. Drug-resistance testing targeting the HIV-1 RT gene was determined. Patients were on first line ART that consisted of two NRTIs, and one NNRTI. RESULTS: Females were younger (mean 42) than males (mean 45) and lower median CD4+ counts (139 cells/µl) than males (152 cells/µl). The prevalence of drug resistance mutations (any major mutation) in this population was 23.1% (15/65). Major NRTI mutations were detected in 11 patient samples, which included M184V (n = 6), M41L (n=3), D67N (n=2), K219Q (n=3) and T215F (n=2). Major NNRTI mutations were detected in 14 patient samples. They included K103N (n = 10), G190A (n = 1), Y181C (n = 1) and Y188L (n = 1). CONCLUSION: Presence of major mutations in this study calls for proper laboratory infrastructure to monitor treatment as well as regular appraisals of available regimens.

Predominance of Hepatitis B Virus Genotype A Among Treated HIV Infected Patients Experiencing High Hepatitis B Virus Drug Resistance in Nairobi, Kenya.

Hepatitis B virus (HBV)-HIV coinfections are becoming common with information on HBV genetic diversity and drug resistance still remaining elusive. To evaluate the HBV genetic diversity and drug resistance-associated mutations among drug-experienced HIV patients, the genetic analysis of the partial HBV-pol-reverse trancriptase gene was successfully sequenced from 13 samples. Analysis of the sequences showed that all (11) the sequences belonged to genotype A. Nucleos(t)ide drug resistance mutations were found in 6 patients. Five subjects had rtV173L, rtL180M, and rtM204V and one with rtL180M and rtM204V major mutations. HBV genotype A remains the most predominant genotype circulating in Nairobi city with detected high level of HBV drug resistance to lamivudine, telbivudine, and emtricitabine. The detected circulating HBV genotype A in Nairobi reflects its possible spread in the population with its origin being within the country. We suggest that patients should not be on lamivudine monotherapy. These individuals should be managed on combination of tenofovir plus lamivudine or emtricitabine therapy to prevent the emergence of HBV drug resistant variants alongside a continuous surveillance monitoring of drug resistance and HBV genotypes.

Prevalence and Factors Associated With Hepatitis B and C Co-Infection Among HIV-1-Infected Patients in Kenya.

BACKGROUND: Hepatitis B virus (HBV) and hepatitis C virus (HCV) are among the most chronic viral infections worldwide. Co-infections with HBV and HCV have become increasingly common among people living with HIV, resulting in a growing public health concern. The primary aim of our study was to determine the prevalence of HBV and HCV and their associated factors among HIV-1-infected patients attending the Ngong Sub-County Hospital comprehensive care clinic. METHODS: After providing consent, a 5 mL blood sample was collected from each study participant visiting the comprehensive care clinic. The blood was screened for hepatitis B surface antigen and HCV antibodies using chemiluminescence immunoassay test according to the manufacturer's instructions. The CD4 T-cell counts were determined using FACSCalibre machine, while HIV-1 viral load was determined using the Abbott m2000rt System according to the manufacturer's instructions. A questionnaire was used to collect sociodemographic information and data on factors associated with HBV and HCV co-infections. RESULTS: One hundred and ninety HIV-1-infected patients participated in this study: 150 (78.9%) women and 40 (21.1%) men. In the overall study population, the prevalence of HBV co-infection was 5.8% (95% CI, 2.6%-8.9%) and of HCV co-infection was 4.2% (95% CI, 1.6%-7.4%). However, no individual was co-infected with all 3 viruses. HCV was associated with antiretroviral treatment (OR 0.2; 95% CI, 0.0-0.8; P=.036), while HBV showed a significant association with condom usage (OR 0.3; 95% CI, 0.1-0.9; P=.039) and median viral load. CONCLUSION: A high prevalence of HIV/HBV and HIV/HCV co-infection was reported in this study, suggesting that HIV-infected patients should be routinely screened for HBV and HCV infections, and preventive and control measures should be put in place that include public education on HBV and HCV infections.

Factors associated with uptake of dual contraception among HIV-infected women in Bungoma County, Kenya: a cross-sectional study.

INTRODUCTION: dual contraception, the use of non-barrier contraceptive method in combination with condoms, is an effective strategy in the elimination of mother-to-child transmission (eMTCT) of human immunodeficiency virus (HIV) and the achievement of zero new HIV infections. Despite its effectiveness, dual contraception use among HIV-infected women in Kenya remains low. We identified factors associated with dual contraceptive uptake in Bungoma County, Kenya. METHODS: this was a facility-based cross-sectional study in eight hospitals in Bungoma County. We interviewed women using structured questionnaires. We calculated descriptive statistics about the womens' baseline characteristics, examined the association between dual contraceptive use and other factors by calculating Odds Ratios (OR) and 95% Confidence Intervals (CI) and performed logistic regression. RESULTS: we recruited 283 HIV-infected women.Among all enrolled women, 190 (67.1%) were aware of dual method and only 109 (38.5%) used dual contraception. The preferred dual pattern was male condom plus injectable contraceptive used by 53.2% of women (58/109). Among the 174 women who did not use dual contraception, 86 (49.4%) preferred using male condoms alone for contraception. Women were more likely to use dual contraception method if they were aware of dual contraception (AOR 12.2, 95% CI 4.7 - 31.7), used non-barrier contraceptives (AOR 9.8 95%; CI 4.5 - 21.3) and had disclosed their HIV status (AOR 7.1 95% CI 2.8 - 18.2) compared to those who did not. CONCLUSION: dual contraceptive prevalence was low. Advocacy on dual contraception as an approach to preventing vertical transmission of HIV should be escalated in order to improve its uptake.