African men who have sex with men (MSM) are at increased risk of HIV infection and may have limited access to quality health care because of social discrimination, stigmatization or criminalization. The HIV Prevention Trials Network (HPTN) 075 evaluated the feasibility of recruiting and retaining MSM in sub-Saharan Africa, in preparation for HIV prevention trials. The study enrolled HIV-infected and HIV-uninfected men at four sites in Kenya, Malawi, and South Africa. We analyzed antiretroviral (ARV) drug use and HIV drug resistance among HIV-infected men screened for participation in HPTN 075.
Laboratory testing was performed using plasma samples collected at the screening visit. ARV drug testing was performed using an assay that detects 20 ARV drugs in 5 drug classes. HIV viral load was measured for men who had ARV drugs detected. Viral suppression was defined as a viral load <400 copies/mL. HIV drug resistance testing was performed using the ViroSeq HIV-1 Genotyping Assay v3.0 for men who had ARV drugs detected with a viral load ≥400 copies/mL. Men who reported knowledge of their HIV status were asked if they were in care and if they had been prescribed ARV drugs for HIV treatment.
ARV drugs were detected in samples from 63 (34.4%) of 183 HIV-infected men at screening. In 57 (90.5%) of the 63 cases, the drugs detected were consistent with ARV treatment (ART; unusual combinations of drugs were detected in two of the 57 cases; efavirenz alone was detected in the remaining six cases). Eleven (17.5%) of the 63 men with ARV drugs detected were not virally suppressed; 6 of those men had drug-resistant HIV (4 NNRTI+NRTI resistance; 1 NNRTI resistance alone; 1 NRTI resistance alone). In multivariate logistic regression, detection of ARV drugs was more frequent among older men (26-44 years; compared to 18-25 years p=0.019), men from Kisumu, Kenya (compared to Blantyre, Malawi [p=0.003], Cape Town, South Africa [p=0.022], and Soweto, South Africa [p=0.016]), and men who reported that they were engaged in HIV care with current or prior ARV drug use (p<0.001).
Most of the HIV-infected men screened for participation in HPTN 075 were not on ART at the screening visit, and many of those on ART were not virally suppressed. Among those who were taking ARV drugs and were not virally suppressed, more than half had drug-resistant HIV and many were at risk of acquiring additional resistance. These findings underscore the importance of improving HIV care for African MSM.