Prevalence of HIV Drug Resistance, its Correlates and Common Mutations Amongst people living with HIV in Northern Uganda. A Cross-Sectional Study.

Background: HIV drug resistance (HIVDR) poses a challenge to the management of people living with HIV (PLHIV), particularly among those experiencing virologic failure. The West–Nile region of Uganda faces HIV treatment challenges and has a high virological failure rate. We sought to estimate the prevalence of HIV drug resistance, describe the HIV drug resistance mutations and evaluate the factors associated with HIVDR among PLHIV with a viral load of ≥1000 copies/mL in the region. Methods: We conducted a cross-sectional analysis of HIVDR data of Non suppressed PLHIV receiving Anti–retroviral therapy (ART) within the region whose HIVDR tests were conducted between January 2021 to December 2023. Demographic and clinical data was extracted from the National HIVDR database. We characterized PLHIV and used logistic regression models to determine factors associated with HIVDR. Results: A total 295 participants records were analyzed where, 133 (45.1%) were adults of 25+ years and 167 (56.6%) were female, the median age was 19 years (interquartile range [IQR]: 3–74 years), and median duration on ART was 8 years (IQR: 1–19 years). Overall, 73.9% (218/295) had HIVDR mutations with 66% of subjects having Non-nucleoside reverse transcriptase mutations. M184V/I (50%), K103N (34%) and TAMS (26%) were the commonest mutations. High rates of resistance to Etravirine (27%) in comparison to other third-line candidate drugs of Dolutegravir (12%) and Darunavir (5%) was also observed. Long duration on ART was associated with presence of HIVDR mutations (aOR=; 1.15 95%CI 1.05 – 1.26 p=0.003). Conclusion: The high HIVDR prevalence in the region, although lower than previous Ugandan reports, underscores the need for routine adherence support VL monitoring and surveillance through genotypic resistance testing to avoid unnecessary switching of PLHIV to costly second–line or third line regimens. High Etravirine resistance reflects past NNRTI reliance, while increasing Dolutegravir resistance may stem from unintended monotherapy due to its pairing with failing NRTIs. Low Darunavir resistance is attributed to its strong genetic barrier. Keywords: HIV, ART, Viral load, HIVDR, Resistance, Mutations, Uganda.