Antiretroviral Drug Use and HIV Drug Resistance Among Young Women in Rural South Africa: HPTN 068

Background: Antiretroviral (ARV) drugs are used for HIV treatment and prevention. We analyzed ARV drug use and HIV drug resistance in a cohort of young women in rural South Africa enrolled in the HPTN 068 study, which evaluated use of a cash transfer conditional on school attendance to reduce HIV incidence. Methods: ARV drug testing was performed using plasma samples from 2,526 young women. This included 2,526 enrollment samples (80 HIV-infected, 2,446 HIV-uninfected) and 162 seroconversion samples (first HIV-positive study visit). Testing was performed using a qualitative assay that detects 20 ARV drugs from five drug classes. HIV drug resistance testing was performed with the ViroSeq HIV-1 Genotyping System for samples that had HIV viral loads ≥400 copies/mL. Results: At enrollment, ARV drugs were detected in 10 (12.5%) of 80 HIV-infected young women. None of 2,446 HIV-uninfected young women had ARV drugs detected at enrollment. ARV drugs were also detected in 16 (9.9%) of 162 seroconverters. At enrollment, nine (13.4%) of 67 young women with genotyping results had HIV drug resistance; resistance was also detected in nine (6.9%) of 131 seroconverters with genotyping results. Conclusions: Most of the HIV-infected young women in this cohort from rural South Africa were not taking ARV drugs, suggesting they were unaware of their HIV status or were not in care. HIV drug resistance was detected in young women with both prevalent and new HIV infection