Antiretroviral drug resistance in HIV-1 patients on first-line therapy or untreated across five treatment centers in Yaounde's Centre Region, Cameroon
Abstract
Antiretroviral therapy (ART) improves HIV survival. However, as ART programs expand in resource-limited settings like Cameroon toward UNAIDS 95-95-95 goals, monitoring drug resistance is critical. This study investigated HIV-1 subtypes and resistance mutations in Yaoundé, Cameroon. From 2017 to 2021, 231 HIV-positive individuals (treatment-naïve and ART-experienced patients with virological failure [viral load >1,000 copies/mL]) were enrolled across five clinics. Plasma samples were sequenced for reverse transcriptase (RT) and protease (PR) genes. Participants were predominantly female (67.5%), aged 21–35 years. Over half (58.5%) received ART (median duration: 6 months). High median viral load (536,263 copies/mL) indicated poor suppression. CRF02_AG dominated (64.5%), followed by A1 (11.7%) and G (6.9%). Resistance mutations were detected in 18.2% of ART-experienced and 13.4% of treatment-naïve participants, indicating acquired and transmitted resistance. NNRTI resistance occurred in 6.1% (ART-experienced) and 1.3% (naïve); NRTI mutations were rare (0.4%). Key mutations included M184V (NRTI) and K103N (NNRTI). Protease inhibitor (PI) resistance was prevalent (19.5%), with I54V most common. Notably, PI resistance was detected in treatment-naïve individuals. CRF02_AG dominance and high resistance rates underscore challenges to ART efficacy. Significant PI resistance in untreated patients suggests transmission of resistant strains. These findings highlight urgent needs for enhanced resistance surveillance and optimized ART strategies in Cameroon.
Keywords: First-line antiretroviral therapy, HIV-1 drug resistance, viral subtype, transmitted drug resistance, Centre, Transversal study
Keywords:
First-line Antiretroviral therapy, HIV-1 drug resistance, viral subtype, transmitted drug resistance, Transversal studyDOI
https://doi.org/10.22270/jddt.v15i5.7126References
1. World Health Organization. Prevalence of HIV in the world. Available at: https://www.who.int/teams/global-hiv-hepatitis-and-stis-programmes/data-use/hiv-data-and-statistics
2. Johnston V, Fielding KL, Charalambous S, Churchyard G, Phillips A, Grant AD. Outcomes following virological failure and predictors of switching to second-line antiretroviral therapy in a South African treatment program. J Acquir Immune Defic Syndr. 2012;61(3):370-80. https://doi.org/10.1097/QAI.0b013e318266ee3f PMid:22820803 PMCid:PMC3840925
3. Kuritzkes DR. Preventing and managing antiretroviral drug resistance. AIDS Patient Care STDS. 2004;18(4):259-73. https://doi.org/10.1089/108729104323076007 PMid:15186710
4. DeGruttola V, Dix L, D'Aquila R, Holder D, Phillips A, Ait-Khaled M, Baxter J, Clevenbergh P, Hammer S, Harrigan R, Katzenstein D, Lanier R, Miller M, Para M, Yerly S, Zolopa A, Murray J, Patick A, Miller V, Castillo S, Pedneault L, Mellors J. The relation between baseline HIV drug resistance and response to antiretroviral therapy: re-analysis of retrospective and prospective studies using a standardized data analysis plan. Antivir Ther. 2000;5:41-8. https://doi.org/10.1177/135965350000500112 PMid:10846592
5. Wainberg MA, Zaharatos GA, Brenner BG. Mechanisms of disease development of antiretroviral drug resistance. N Engl J Med. 2011;365(1):37-46. https://doi.org/10.1056/NEJMra1004180 PMid:21848464
6. Sigaloff KC, Hamers RL, Wallis CL, Kityo C, Siwale M, Ive P, Botes ME, Mandaliya K, Wellington M, Osibogun A, Stevens WS, van Vugt M, de Wit TF. Unnecessary antiretroviral treatment switches and accumulation of HIV resistance mutations; two arguments for viral load monitoring in Africa. J Acquir Immune Defic Syndr. 2011;58(1):23-31. https://doi.org/10.1097/QAI.0b013e318227fc34 PMid:21694603
7. Boulle A, Van Cutsem G, Cohen K, Hilderbrand K, Mathee S, Abrahams M, Goemaere E, Coetzee D, Maartens G. Outcomes of nevirapine- and efavirenz-based antiretroviral therapy when coadministered with rifampicin-based antitubercular therapy. JAMA. 2008;300(5):530-9. https://doi.org/10.1001/jama.300.5.530 PMid:18677025
8. Pasquet A, Messou E, Gabillard D, Minga A, Depoulosky A, Deuffic-Burban S, Losina E, Freedberg KA, Danel C, Anglaret X, Yazdanpanah Y. Impact of drug stock-outs on death and retention to care among HIV-infected patients on combination antiretroviral therapy in Abidjan, Côte d'Ivoire. PLoS One. 2010;5(10):e13414. https://doi.org/10.1371/journal.pone.0013414 PMid:20976211 PMCid:PMC2955519
9. Wainberg MA, Zaharatos GJ, Brenner BG. Development of antiretroviral drug resistance. N Engl J Med. 2011;365(7):637-46. https://doi.org/10.1056/NEJMra1004180 PMid:21848464
10. Wainberg MA. HIV-1 Subtype Distribution and the Problem of Drug Resistance. AIDS. 2004;18 Suppl 3:S63-8. https://doi.org/10.1097/00002030-200406003-00012 PMid:15322487
11. Kantor R, Katzenstein D. Drug Resistance in Non-Subtype B HIV-1. J Clin Virol. 2004;29(3):152-9. https://doi.org/10.1016/S1386-6532(03)00115-X PMid:14962783
12. Ojesina AI, Sankalé JL, Odaibo G, Langevin S, Meloni ST, Sarr AD, Olaleye D, Kanki PJ. Subtype-Specific Patterns in HIV Type 1 Reverse Transcriptase and Protease in Oyo State, Nigeria: Implications for Drug Resistance and Host Response. AIDS Res Hum Retroviruses. 2006;22(8):770-9. https://doi.org/10.1089/aid.2006.22.770 PMid:16910833
13. World Health Organization. Antiretroviral therapy for HIV infection in adults and adolescents: recommendations for a public health approach. 2010. Available at: http://www.who.int/hiv/pub/arv/adult2010/en/index.html
14. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating and preventing HIV infection. 2013. Available at: http://www.who.int/hiv/pub/guidelines/arv2013/en/
15. World Health Organization. Consolidated guidelines on the use of antiretroviral drugs for treating HIV infection: recommendations for a public health approach. 2nd ed. 2016. Available at: http://www.who.int/hiv/pub/arv/arv-2016/en/
16. Agyingi L, Barengolts D, Mayr L, Kinge T, MBida M, Nyambi P. Genetic variability and drug resistance mutations in HIV-1 infected individuals on HAART or drug naïve in Limbe, Cameroon. Retrovirology. 2012;9 Suppl 2:P158. https://doi.org/10.1186/1742-4690-9-S2-P158 PMCid:PMC3441775
17. Ceccarelli L, Salpini R, Moudourou S, Cento V, Santoro MM, Fokam J, Takou D, Nanfack A, Dori L, Torimiro J, Sarmati L, Andreoni M, Perno CF, Colizzi V, Cappelli G. Characterization of drug resistance mutations in naive and ART-treated patients infected with HIV-1 in Yaounde, Cameroon. J Med Virol. 2012;84(5):721-7. https://doi.org/10.1002/jmv.23244 PMid:22431019
18. Kinyua JG, Lihana RW, Kiptoo M, Muasya T, Odera I, Muiruri P, Songok EM. Antiretroviral resistance among HIV-1 patients on first-line therapy attending a comprehensive care clinic in Kenyatta National Hospital, Kenya: a retrospective analysis. Pan Afr Med J. 2018;29:186. https://doi.org/10.11604/pamj.2018.29.186.10796 PMid:30061964 PMCid:PMC6061825
19. Meriki HD, Tufon KA, Anong DN, Atanga PN, Anyangwe IA, Cho-Ngwa F, Nkuo-Akenji T. Genetic diversity and antiretroviral resistance-associated mutation profile of treated and naive HIV-1 infected patients from the Northwest and Southwest regions of Cameroon. PLoS One. 2019;14(11):e0225575. https://doi.org/10.1371/journal.pone.0225575 PMid:31751428 PMCid:PMC6874083
20. Kurt Yilmaz N, Swanstrom R, Schiffer CA. Improving Viral Protease Inhibitors to Counter Drug Resistance. Trends Microbiol. 2016;24(7):547-57. https://doi.org/10.1016/j.tim.2016.03.010 PMid:27090931 PMCid:PMC4912444
21. Mata-Munguía C, Escoto-Delgadillo M, Torres-Mendoza B, Flores-Soto M, Vázquez-Torres M, Gálvez-Gastelum F, Viniegra-Osorio A, Castillero-Manzano M, Vázquez-Valls E. Natural polymorphisms and unusual mutations in HIV-1 protease with potential antiretroviral resistance: a bioinformatic analysis. BMC Bioinformatics. 2014;15:72. https://doi.org/10.1186/1471-2105-15-72 PMid:24629078 PMCid:PMC4003850
22. Coffin J, Swanstrom R. HIV Pathogenesis: Dynamics and Genetics of Viral Populations and Infected Cells. Cold Spring Harb Perspect Med. 2013;3(1):a012526. https://doi.org/10.1101/cshperspect.a012526 PMid:23284080 PMCid:PMC3530041
23. Rhee SY, Sankaran K, Varghese V, Winters MA, Hurt CB, Eron JJ, Parkin N, Holmes SP, Holodniy M, Shafer RW. HIV-1 Protease, Reverse Transcriptase, and Integrase Variation. J Virol. 2016;90(13):6058-70. https://doi.org/10.1128/JVI.00495-16 PMid:27099321 PMCid:PMC4907232
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