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

This study investigated the prevalence of recent HIV-1 infections (RHI), defined as infections acquired within the past six months, among newly diagnosed, antiretroviral therapy (ART)-naïve people living with HIV (PLHIV) at a rural referral hospital in Tanzania, and assessed pre-treatment HIV-1 drug resistance (PDR) and circulating viral subtypes in this group. Among 599 participants, 4% were identified with RHI using the Asante HIV-1 Rapid Recency Assay combined with viral load testing, with no demographic or clinical factors significantly associated with recent infection. Genotypic resistance testing was successful in 67% of RHI cases, revealing that 31% harbored drug resistance mutations, predominantly against non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs), and protease inhibitors (PIs). The findings highlight a low rate of early HIV diagnosis in this rural setting and a notable prevalence of drug resistance among recent infections, underscoring the importance of early detection and resistance monitoring to inform effective treatment strategies.