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Transmitted HIV-1 Drug resistance and the Role of Herpes Simplex Virus -2 Coinfection among Fishermen along the Shores of Lake Victoria, Kisumu, Kenya

Victor Mburu Macharia, Caroline Ngugi, Raphael Lihana and Musa Otieno Ngayo

Introduction: Herpes simplex virus type 2 (HSV-2) infection has been associated with a 3-fold risk of HIV-1 acquisition. The prevalence of HIV-1 and HSV-2 in the fishing communities along the shores of Lake Victoria in Kisumu have been reported to be high. This may contribute to the growing HIV epidemic in Kenya including the spread of transmitted drug resistance (TDR). We report data on the association of HSV2/HIV-1 co-infection and TDR in this antiretroviral (ARV)-naïve population. Methods: Blood samples were obtained from 249 consenting fishermen from 5 beaches and a detailed sociodemographic questionnaire was administered. Blood samples were analyzed for HIV-1/HSV2 co-infection. The HSV-2 serology was performed using Kalon HSV type 2 enzyme-linked immunosorbent assay (ELISA). The HIV-1 counselling and serology were carried out according to local standards of practice in Kenya, using two parallel rapid assays (Alere Determine HIV-1/2 and Trinity Biotech Uni- Gold), with a third ELISA-Vironostika HIV Uni-Form II Ag/Ab for resolving discrepancies. All HIV positive samples were tested for TDR using an in house HIV-1 pol-RT genotyping protocol. Results: Of the 249 recruited fishermen (mean age 35.1 years), 134 (53.8%) were positive for HSV-2, 59 (23.7%) were HIV positive while 48 (19.3%) were HIV/HSV-2 coinfected. Twenty-three of 59 (38.9%) HIV positive men had TDR, with the majority (19/23, 82.6%) in HIV/HSV-2 coinfected fishermen. Among the 48 HIV/HSV-2 co-infected fishermen, 9 had nucleoside reverse-transcriptase inhibitor (NRTI) resistance mutations with NRTI- associated mutations [NAMS], M184V (77.8%) and K65R (11.1%) being the highest. Nineteen (19) fishermen had Non-NRTI (NNRTIs) mutations including; four (21.1%) each of K103N, Y181C and G190A. Three (15.7%) V179T, two V901V and single A98G and Y188L mutations. Among the 11 fishermen who had HIV-1 mono-infection, four (36.4%) had drug resistant mutations. One fisherman had NRTI resistance mutation M184V. In addition, three men (3/4) had NNRTI resistance; K103N, G190A and Y181C mutations each. In the regression model, HIV/HSV-2 co-infection was independently associated with TDR [OR 4.1 (95% CI 1.4 to 11.9)]. Conclusion: The level of TDR to NNRTIs in these ARV-naive fishermen was significantly high especially among those coinfected with HSV-2. HSV-2 infection may increase the risk of TDR in this population.