Prevalence of pretreatment drug resistance in persons initiating and reinitiating antiretroviral therapy in Sri Lanka: results from a national representative survey

BACKGROUND

We conducted a nationwide cross-sectional study to estimate pretreatment drug resistance (PDR) prevalence in adults initiating ART in Sri Lanka following the WHO's recommendations.

METHODS

HIV drug resistance was determined on dried blood spots (DBSs) using population-based sequencing of the protease and reverse transcriptase genes and interpretation was based on Stanford HIVdb v9.0. Analyses were weighted to adjust for multistage sampling and genotypic failure rate. We used logistic regression to assess differences between groups.

RESULTS

Overall, in 10% (15 of 150) of patients initiating ART, HIV drug resistance mutations were detected. The prevalence of resistance to NNRTI drugs efavirenz/nevirapine was 8.4% (95% CI 4.6-15.0) but differed among those reporting having prior antiretroviral (ARV) exposure (24.4%, 95% CI 13.8-39.5) compared with 4.6% (95% CI 1.6-12.8) for those reporting as being ARV naive (OR 4.6, 95% CI 1.3-16.6, P = 0.021). PDR to efavirenz/nevirapine was also nearly twice as high among women (14.1%, 95% CI 6.1-29.4) compared with men (7.0%, 95% CI 3.1-14.7) (P = 0.340) and three times high among heterosexuals (10.4%, 95% CI 2.4-35.4) compared with MSM (3.8%, 95% CI 1.1-12.7) (P = 0.028). NRTI PDR prevalence was 3.8% (95% CI 1.1-12.1) and no PI PDR was observed in the study.

CONCLUSIONS

A high prevalence of efavirenz/nevirapine PDR was reported, especially in patients with prior ARV exposure, in women and those reporting being heterosexual. These findings highlight the need to fast-track the transition to the WHO-recommended dolutegravir-based first-line ART.

The prevalence of hepatitis B surface antigen in the Gampaha district

OBJECTIVE

To assess the prevalence and some epidemiological features of hepatitis B surface antigen (HBsAg) status in the Gampaha district.

DESIGN

Community based survey.

SETTING

The district of Gampaha.

SUBJECTS

All individuals over six months of age who were resident in the Gampaha district for a period over one month at time of survey.

RESULTS

The HBsAg positivity rate in the Gampaha district was estimated to be 2.5% (95% C.I. 2% to 3%). This places the area in the intermediate endemicity zone as classified by WHO. The epidemiology indicates horizontal intrafamilial spread being more important in the population studied, than vertical, parenteral or sexual routes of transmission.

CONCLUSIONS

The study suggests that immunisation in early childhood is an important measure in prevention of the infection in this district.

A case control study to assess the efficacy of measles vaccine

OBJECTIVE

To measure the efficacy of measles vaccination in a given geographical area.

DESIGN

Population based case control study.

SETTING

Medical Officer of Health area, Kotte.

SUBJECTS

All children born after January 1985 and registered by the midwives of the area.

RESULTS

Vaccine efficacy was 88.9%, the 95% confidence limits being 65.21% to 96.5%.

CONCLUSION

The method described is a suitable alternative to the more expensive serological estimates of vaccine efficacy.