Journal Article

Clinical, Psychosocial, and Structural Factors Associated with the Detection of HIV Drug Resistance in Children Living with HIV in Kisumu, Kenya: Secondary Analysis of Data from the Opt4Kids Study

Patel, Rena C., Chohan, Bhavna H., Odhiambo, Francesca, Brown, Evelyn, Yongo, Nashon, Oyaro, Patrick, Karauki, Enericah, Frenkel, Lisa M., Scallon, Andrea J., Hassan, Shukri A., Bishop, Marley D., Maheria, Pooja, Thomas, Katherine K., Abuogi, Lisa, Beck, Ingrid A., Ochomo, Edwin, Boyce, Ceejay

2025

Overview

Background: HIV drug resistance (DR) mutations can compromise antiretroviral therapy (ART) success among children living with HIV (CLHIV). We conducted a secondary analysis using data from a randomized control trial for ART monitoring among CLHIV in Kisumu County, Kenya from 2019 to 2023, to assess clinical, psychosocial, and structural factors associated with HIV DR. Methods: 704 CLHIV were followed for 12+ months, with characteristics captured at enrollment and follow-up visits in the “parent” randomized-controlled-trial (of point-of-care plasma viral load testing and for viremias ≥ 1000 copies/mL HIV genotyping for DR vs. standard-of-care) and an observational “extension” substudy (of participants on a dolutegravir-containing ART with genotyping performed on viremic specimens ≥ 200 copies/mL). A multivariate modified Poisson regression model was used to analyze factors associated with sequences yielding a Stanford HIVDR database DR penalty score (DR-PS) ≥ 30 to a nucleos(t)ides and/or non-nucleoside reverse transcriptase inhibitor, protease inhibitor (PI), and/or integrase inhibitor (INSTI). Results: Among 113 (16.1%) participants who underwent genotyping, 93 (82.3%) had a DR-PS ≥ 30. DR-PS ≥ 30 were associated with age 1–5 years (adjusted risk ratio (ARR) = 1.84; 95% confidence interval (CI): 1.07, 3.14), history of viremia ≥ 1000 copies/mL (ARR = 4.18; 95% CI: 2.77, 6.31), prescription of a PI- (ARR = 6.05; 95% CI: 3.43, 10.68) or INSTI-containing regimen (ARR = 1.83; 95% CI: 1.08, 3.11), poor adherence to ART (ARR = 1.91; 95% CI: 1.32, 2.76), lack of caregiver confidence in ART administration (ARR = 1.89; 95% CI: 1.11, 3.22), and mid-sized clinic populations (ARR = 0.55; 95% CI: 0.33, 0.92). Conclusion: Addressing social factors associated with DR-PS ≥ 30 may improve ART success among CLHIV.

• Publisher: MDPI AG
• Subject: Abused women / Adolescent / Age / Anti-HIV agents / Anti-HIV Agents - pharmacology / Anti-HIV Agents - therapeutic use / Antiretroviral therapy / Antiviral agents / Caregivers / Child / Child, Preschool / children / Clinical decision making / DNA polymerases / Drug dosages / Drug resistance / drug resistance mutation (DRM) / Drug Resistance, Viral - genetics / Drug therapy / Enrollments / Female / Genotype / Genotyping / Heterocyclic Compounds, 3-Ring - therapeutic use / Highly active antiretroviral therapy / HIV / HIV (Viruses) / HIV Infections - drug therapy / HIV Infections - epidemiology / HIV Infections - psychology / HIV Infections - virology / HIV-1 - drug effects / HIV-1 - genetics / Human immunodeficiency virus / Humans / Infant / Integrase / Intervention / Kenya / Kenya - epidemiology / Laboratories / Male / Non-nucleoside reverse transcriptase inhibitors / Nucleoside reverse transcriptase inhibitors / Oxazines / Pediatrics / Piperazines / Protease inhibitors / Proteases / Proteinase inhibitors / Psychological aspects / Pyridones / Reverse transcriptase inhibitors / RNA-directed DNA polymerase / Secondary Data Analysis / Social aspects / Social factors / viral failure / Viral Load - drug effects / Viremia