Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019-2021: A national study

Limited epidemiologic studies have been conducted in Jordan describing the HIV epidemic. This study aimed to address this gap to inform HIV prevention and control. A nationally-representative cross-sectional study was conducted among adults living with HIV in Jordan. Laboratory testing included HIV...

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Published in:	International journal of infectious diseases Vol. 145; p. 107079
Main Authors:	Bakri, Faris G., Mukattash, Heyam H., Esmeiran, Hiam, Schluck, Glenna, Storme, Casey K., Broach, Erica, Mebrahtu, Tsedal, Alhawarat, Mohammad, Valencia-Ruiz, Anais, M'Hamdi, Oussama, Malia, Jennifer A., Hassen, Zebiba, Shafei, Mah'd M.S., Alkhatib, Ala Y., Gazo, Mahmoud, Jaradat, Saied A., Gomez, Yessenia, McGeehon, Samantha, McCauley, Melanie D., Moreland, Sarah C., Darden, Janice M., Amare, Mihret, Crowell, Trevor A., Vasan, Sandhya, Michael, Nelson L., Ake, Julie A., Modjarrad, Kayvon, Scott, Paul T., Peel, Sheila A., Hakre, Shilpa
Format:	Journal Article
Language:	English
Published:	Canada Elsevier Ltd 01-08-2024 Elsevier
Subjects:	Adolescent Adult Anti-HIV Agents - pharmacology Anti-HIV Agents - therapeutic use Antiretroviral resistance Cross-Sectional Studies Drug Resistance, Viral - genetics Female Genotype HIV HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - virology HIV-1 - drug effects HIV-1 - genetics Humans Jordan Jordan - epidemiology Male Middle Aged Molecular epidemiology Viral Load Young Adult Jordan Molecular epidemiology HIV Jordan Antiretroviral resistance
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Summary:	Limited epidemiologic studies have been conducted in Jordan describing the HIV epidemic. This study aimed to address this gap to inform HIV prevention and control. A nationally-representative cross-sectional study was conducted among adults living with HIV in Jordan. Laboratory testing included HIV viral load and next-generation-sequencing-based clinical genotype. Log-binomial regression estimated risk ratios (RRs) and 95% confidence intervals (CIs). Among 231 (70%) participants, most were male (184/80%), and from Jordan (217/94%). Among 188 treatment-experienced-participants (>6 months), 165 (88%) were virally suppressed. High-level resistance was most frequent against nucleoside reverse transcriptase inhibitor (13/81%), and integrase-strand transfer inhibitor (INSTI) (10/62%) drugs among viremic (≥1000 HIV copies/mL) treatment-experienced participants with drug-resistant mutations (DRMs, n = 16). Common HIV subtypes (n = 43) were B (6/14%), A1 (5/12%), and CRF01_AE (5/12%); additionally, novel recombinant forms were detected. In multivariate analysis, independently higher risk for late diagnosis (n = 49) was observed with diagnosis through blood donation (vs check-up: RR 2.20, 95%CI 1.16-4.17) and earlier time-period of diagnosis (1986-2014 vs 2015-2021: RR 2.87, 95%CI 1.46-5.62). Late diagnosis and INSTI resistance endanger national HIV prevention and treatment in Jordan—high-level resistance to INSTI suggests therapeutic drug monitoring is needed for treatment efficacy and conservation of treatment options.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	1201-9712 1878-3511 1878-3511
DOI:	10.1016/j.ijid.2024.107079