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Peer-reviewedCC BY 4.0Communications Medicine

Geospatial analysis reveals similar HIV-1 drug resistance patterns among antiretroviral therapy-experienced children and adolescents (0-17 years) of South Africa

  • Lilishia Gounder1,2
  • Moherndran Archary3
  • Aabida Khan1,2
  • Kerusha Govender1
  • Raveen Parboosing1,4
  • Kogieleum Naidoo5,6
  • Benjamin Chimukangara1,5,7
7 affiliations
  1. 1Department of Virology, School of Medicine, University of KwaZulu-Natal, Durban, South Africa
  2. 2Department of Virology, National Health Laboratory Service, Inkosi Albert Luthuli Central Hospital, Durban, South Africa
  3. 3Department of Paediatrics, University of KwaZulu-Natal, Durban, South Africa
  4. 4School of Pathology, University of Witwatersrand & National Health Laboratory Service, Johannesburg, South Africa
  5. 5Centre for the AIDS Programme of Research in South Africa (CAPRISA), Durban, South Africa
  6. 6South African Medical Research Council (SAMRC), CAPRISA HIV-TB Pathogenesis and Treatment Research Unit, Durban, South Africa
  7. 7Critical Care Medicine Department, NIH Clinical Center, Bethesda, MD USA
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Abstract

Background: HIV-1 drug resistance (HIVDR) complicates antiretroviral therapy (ART) in children and adolescents living with HIV (CALWH), particularly in high-prevalence areas such as KwaZulu-Natal, South Africa. This study describes trends in HIVDR and patterns by drug class and geographic location among ART-experienced CALWH in KwaZulu-Natal.

Methods: We analysed 914 routine HIV-1 genotypic resistance tests (GRTs) obtained between January 2018 and June 2022 from 0–17-year-old CALWH, integrating facility-linked Geographic Information Systems (GIS) coordinates for geospatial, descriptive and logistic regression analyses.

Results: Here we show that 80.96% (740/914) of GRTs from CALWH (median age 13, interquartile range 7-15 years) across 114 facilities demonstrate HIVDR. Of the 740 individuals with HIVDR, 609 (82.30%) had non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, and among them, 32 (5.25%) were on NNRTI treatment. Additionally, 525 (70.95%) had nucleoside reverse transcriptase inhibitor (NRTI) mutations, and 181 (24.46%) had major protease inhibitor (PI) mutations. One in every 6 GRTs with HIVDR (129/740; 17.43%) have triple-class NRTI, NNRTI and PI mutations. When analysed by age, ~9 in every 10 GRTs from CALWH aged 0-9 years (237/257, 92.22%) have HIVDR, compared to 76.56% (503/657) aged 10-17 years (OR = 3.63, 95% CI: 2.22-5.93, p < 0.001). GIS-interpolation maps show potential-low-level resistance to tenofovir, low-to-intermediate-level resistance to abacavir (high-level in northern localities) and intermediate-to-high-level resistance to lamivudine, nevirapine and efavirenz.

Conclusions: Routine GRTs demonstrate high HIVDR prevalence among younger children, while ART susceptibility maps show overall uniformity with variations in certain regions, such as northern KwaZulu-Natal localities. GIS-linked real-time monitoring of HIVDR is crucial to assess the impact of the revised HIV-1 treatment guidelines for CALWH in South Africa.

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Cite

BibTeXRIS
BibTeX
@article{gounder2026geospatial,
  title = {{Geospatial analysis reveals similar HIV-1 drug resistance patterns among antiretroviral therapy-experienced children and adolescents (0-17 years) of South Africa}},
  author = {Lilishia Gounder and Moherndran Archary and Aabida Khan and Kerusha Govender and Raveen Parboosing and Kogieleum Naidoo and Benjamin Chimukangara},
  journal = {Communications Medicine},
  year = {2026},
  month = jul,
  doi = {10.1038/s43856-026-01770-9},
  url = {https://doi.org/10.1038/s43856-026-01770-9},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Geospatial analysis reveals similar HIV-1 drug resistance patterns among antiretroviral therapy-experienced children and adolescents (0-17 years) of South Africa
AU  - Lilishia Gounder
AU  - Moherndran Archary
AU  - Aabida Khan
AU  - Kerusha Govender
AU  - Raveen Parboosing
AU  - Kogieleum Naidoo
AU  - Benjamin Chimukangara
PY  - 2026
DA  - 2026/07/07
JO  - Communications Medicine
DO  - 10.1038/s43856-026-01770-9
UR  - https://doi.org/10.1038/s43856-026-01770-9
AB  - Background: HIV-1 drug resistance (HIVDR) complicates antiretroviral therapy (ART) in children and adolescents living with HIV (CALWH), particularly in high-prevalence areas such as KwaZulu-Natal, South Africa. This study describes trends in HIVDR and patterns by drug class and geographic location among ART-experienced CALWH in KwaZulu-Natal.  Methods: We analysed 914 routine HIV-1 genotypic resistance tests (GRTs) obtained between January 2018 and June 2022 from 0–17-year-old CALWH, integrating facility-linked Geographic Information Systems (GIS) coordinates for geospatial, descriptive and logistic regression analyses.  Results: Here we show that 80.96% (740/914) of GRTs from CALWH (median age 13, interquartile range 7-15 years) across 114 facilities demonstrate HIVDR. Of the 740 individuals with HIVDR, 609 (82.30%) had non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations, and among them, 32 (5.25%) were on NNRTI treatment. Additionally, 525 (70.95%) had nucleoside reverse transcriptase inhibitor (NRTI) mutations, and 181 (24.46%) had major protease inhibitor (PI) mutations. One in every 6 GRTs with HIVDR (129/740; 17.43%) have triple-class NRTI, NNRTI and PI mutations. When analysed by age, ~9 in every 10 GRTs from CALWH aged 0-9 years (237/257, 92.22%) have HIVDR, compared to 76.56% (503/657) aged 10-17 years (OR = 3.63, 95% CI: 2.22-5.93, p < 0.001). GIS-interpolation maps show potential-low-level resistance to tenofovir, low-to-intermediate-level resistance to abacavir (high-level in northern localities) and intermediate-to-high-level resistance to lamivudine, nevirapine and efavirenz.  Conclusions: Routine GRTs demonstrate high HIVDR prevalence among younger children, while ART susceptibility maps show overall uniformity with variations in certain regions, such as northern KwaZulu-Natal localities. GIS-linked real-time monitoring of HIVDR is crucial to assess the impact of the revised HIV-1 treatment guidelines for CALWH in South Africa.
SN  - 2730-664X
ER  -