Clinical, molecular, and drug resistance epidemiology of HIV in Jordan, 2019-2021: a national study.
Int J Infect Dis 2024:107079. [PMID:
38697607 DOI:
10.1016/j.ijid.2024.107079]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2024] [Revised: 04/01/2024] [Accepted: 04/28/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND
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.
METHODS
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).
RESULTS
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 (≥1,000 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).
CONCLUSIONS
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.
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