{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,3]],"date-time":"2026-09-03T11:08:22Z","timestamp":1788433702542,"version":"build-2803163510"},"reference-count":54,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2024,10,19]],"date-time":"2024-10-19T00:00:00Z","timestamp":1729296000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"European &amp; Developing Countries Clinical Trials Partnership (EDCTP)","award":["TMA2019CDF\u20132728 (HIVDR-MIT)"],"award-info":[{"award-number":["TMA2019CDF\u20132728 (HIVDR-MIT)"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Viruses"],"abstract":"<jats:p>HIV-1 drug resistance (HIVDR) impedes treatment and control of HIV-1, especially in high-prevalence settings such as KwaZulu-Natal (KZN) province, South Africa. This study merged routine HIV-1 genotypic resistance test (GRT) data with Geographic Information Systems coordinates to assess patterns and geographic distribution of HIVDR in KZN, among ART-experienced adults with virological failure. We curated 3133 GRT records generated between 1 January 2018 and 30 June 2022, which includes the early phase of dolutegravir (DTG) rollout, of which 2735 (87.30%) had HIVDR. Of the 2735, major protease, nucleoside, and non-nucleoside reverse transcriptase inhibitor mutations were detected in 41.24%, 84.97% and 88.08% of GRTs, respectively. Additional genotyping of HIV-1 integrase for 41\/3133 (1.31%) GRTs showed that 17\/41 (41.46%) had integrase strand transfer inhibitor resistance. Notably, of 26 patients on DTG with integrase genotyping, 9 (34.62%) had DTG-associated resistance mutations. Dual- or triple-class resistance was observed in four of every five GRTs. The odds of HIVDR increased significantly with age, with \u226560 years having 5 times higher odds of HIVDR compared to 18\u201329 years (p = 0.001). We identified geospatial differences in the burden of HIVDR, providing proof of concept that this could be used for data-driven public health decision making. Ongoing real-time HIVDR surveillance is essential for evaluating the outcomes of the updated South African HIV treatment programme.<\/jats:p>","DOI":"10.3390\/v16101634","type":"journal-article","created":{"date-parts":[[2024,10,21]],"date-time":"2024-10-21T03:57:09Z","timestamp":1729483029000},"page":"1634","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Patterns of HIV-1 Drug Resistance Observed Through Geospatial Analysis of Routine Diagnostic Testing in KwaZulu-Natal, South Africa"],"prefix":"10.3390","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1060-9170","authenticated-orcid":false,"given":"Lilishia","family":"Gounder","sequence":"first","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aabida","family":"Khan","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8874-907X","authenticated-orcid":false,"given":"Justen","family":"Manasa","sequence":"additional","affiliation":[{"name":"Department of Oncology, Faculty of Medicine and Health Sciences, University of Zimbabwe, Mount Pleasant, Harare P.O. Box MP 167, Zimbabwe"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0926-710X","authenticated-orcid":false,"given":"Richard","family":"Lessells","sequence":"additional","affiliation":[{"name":"KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew","family":"Tomita","sequence":"additional","affiliation":[{"name":"KwaZulu-Natal Research Innovation and Sequencing Platform (KRISP), College of Health Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Centre for Rural Health, School of Nursing and Public Health, University of KwaZulu-Natal, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melendhran","family":"Pillay","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0680-7337","authenticated-orcid":false,"given":"Sontaga C.","family":"Manyana","sequence":"additional","affiliation":[{"name":"Biomedical Research and Innovation Platform (BRIP), South African Medical Research Council (SAMRC), Pretoria 0001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Subitha","family":"Govender","sequence":"additional","affiliation":[{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerri-Lee","family":"Francois","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pravi","family":"Moodley","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0610-6100","authenticated-orcid":false,"given":"Nokukhanya","family":"Msomi","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5189-0734","authenticated-orcid":false,"given":"Kerusha","family":"Govender","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5476-1011","authenticated-orcid":false,"given":"Raveen","family":"Parboosing","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"School of Pathology, University of Witwatersrand & National Health Laboratory Service, Johannesburg 2000, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3821-4592","authenticated-orcid":false,"given":"Sikhulile","family":"Moyo","sequence":"additional","affiliation":[{"name":"Botswana Harvard Health Partnership, Gaborone P.O. Box B0320, Botswana"},{"name":"Department of Immunology & Infectious Diseases, Harvard T.H. Chan School of Public Health, Boston, MA 02115, USA"},{"name":"Department of Pathology, Division of Medical Virology, Stellenbosch University, Cape Town 7500, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8874-6661","authenticated-orcid":false,"given":"Kogieleum","family":"Naidoo","sequence":"additional","affiliation":[{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban 4001, South Africa"},{"name":"CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, South African Medical Research Council (SAMRC), Durban 4001, South Africa"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Benjamin","family":"Chimukangara","sequence":"additional","affiliation":[{"name":"Department of Virology, School of Laboratory Medicine and Medical Sciences, University of KwaZulu-Natal, Durban 4001, South Africa"},{"name":"Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban 4001, South Africa"},{"name":"Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD 20892, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,19]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"e479","DOI":"10.1016\/S2352-3018(24)00102-4","article-title":"Moving beyond hotspots of HIV prevalence to geospatial hotspots of UNAIDS 95-95-95 targets in sub-Saharan Africa","volume":"11","author":"Cuadros","year":"2024","journal-title":"Lancet HIV"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1000294","DOI":"10.4172\/2155-6113.1000299","article-title":"HIV drug resistance patterns at the epicentre of the HIV-1 epidemic in Kwazulu-Natal, South Africa 2003\u20132013","volume":"5","author":"Kiepiela","year":"2014","journal-title":"J. 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