Odine KOME1
1Faculty of medicine and biomedical sciences, university of Yaounde I
CaHReF 2018, Yaoundé Congres hall, 08 – 11 January 2019 , OAEI023
Background: With the scale-up of antiretroviral therapy (ART), pre-treatment drug resistance (PDR) appears 10% in many developing countries. With the Northwest region having the second epidemiological burden of HIV infection, it would be of great relevance to generate data on PDR in this region, for evidence-based decision-making according to geographical settings.
Objectif: To ascertain levels of PDR amongst ART-initiators and HIV-1 clade dispersal in an urban setting and their potential association with subtype distribution and CD4-staging.
Methodology: A cross-sectional study was conducted from February-April 2017 amongst patients recently diagnosed with HIV-infections and initiating ART at the Bamenda regional Hospital (urban setting). Protease and reverse transcriptase sequencing was performed using an in-house protocol and drug resistance mutations (DRMs) were interpreted using Stanford HIVdb.v8.3. Phylogeny was performed for subtype assignation.
Results: We generated 31 patient sequences (median age: 38 years old; 58.10% female; median CD4: 184 [IQR: 35-387] cells/mm3. PDR level was found to be 12.90% (4/31). DRMs found were as follows: M41ML (2), E44EAD (1), K65R (1), K70E (1), K103N (1), E138A/G (2), V179E (1), M230L (1), M184V/I (2), K219R (1), K238T (1) and P225H (1). Genetic diversity showed CRF02_AG was the most prevalent clade (74.2% [23/31]). We found no association between subtype distribution, CD4 levels and the occurrence of PDR (CRF02_AG (8.7% [2/23]) vs. non-CRF02_AG (25% [2/8]), p=0.27; (CD4 <200 cells/mm3 (14.29% [3/18]) vs. CD4 200 cells/mm3 (7.14% [1/13]), p=0.43.
Conclusion/Recommandation: PDR is at a moderate rate in northwest Cameroon. Though CRF02_AG is the most predominant clade, there is still evidence of viral diversity. However, there is no major effect of HIV molecular epidemiology and CD4-staging on the presence of PDR amongst initiators. Therefore, there is need for close virological monitoring amongst these patients, especially with the presence of K65R mutation that jeopardizes the effectiveness of the current preferred first-line ART.
Key Words: Drug resistance; HIV-1 subtypes; Treatment initiators.