Recent HIV-1 infection and pre-treatment HIV drug resistance among adults initiating antiretroviral therapy in rural Tanzania

BackgroundNew HIV-1 infections continue to pose a major challenge to ending the HIV epidemic and may facilitate the transmission of drug-resistant strains. In this study, we aimed to determine the proportion of recent HIV-1 infections (RHI) among individuals initiating HIV care at a rural referral hospital in Tanzania and to assess the prevalence of pre-treatment HIV-1 drug resistance (PDR) and circulating subtypes among those with RHI.MethodsIn this cross-sectional analysis, RHI was identified using the Asante HIV-1 rapid recency assay on bio-banked samples from newly diagnosed adult people living with HIV (PLHIV) enrolled in the Kilombero and Ulanga Antiretroviral cohort between March 2019 and March 2022. Risk factors for recent HIV were evaluated using logistic regression analysis. Genotypic resistance testing (GRT) using Sanger sequencing was performed on samples from people with RHI.ResultsAmong 599 PLHIV, 24 (4%) were identified with RHI. No factors were found to be associated with RHI. Genotypic resistance testing was successful in 16 of the 24 (67%) participants, of whom 5 (31%) harbored HIV-1 drug resistance mutations: 4/16 (25%) for non-nucleoside reverse transcriptase inhibitors, 2/16 (13%) for nucleoside reverse transcriptase inhibitors, and 1/16 (6%) for protease inhibitors.ConclusionThe low prevalence of RHI in this hospital-based study suggests a high rate of late HIV diagnosis. Despite the limited sample size, the notable proportion of people with recent infection who had drug resistance highlights a serious public health concern.