Background: First line antiretroviral therapy in a resource-limited setting consists of nucleotide
and non-nucleotide reverse transcriptase inhibitors. Protease inhibitors are the hub of second
line therapy. The decision to change antiretroviral therapy for a patient is frequently presumptive
because of the lack of genotypic resistance tests in routine follow-up. We describe here the resistance
profiles observed in patients with varying terms of antiretroviral therapy in Cameroon after
implementation of HIV genotypic resistance testing in routine practice.
Methods: HIV genotypic resistance testing was carried out on consecutive samples received between
August 2013 and November 2015. Protease (Prot) and reverse transcriptase (Rt) genes of the
HIV genome were amplified, sequenced and analyzed for drug resistance mutations following the
algorithm set up by the French National Agency for research on HIV/AIDS and viral hepatitis.
Results: Specimens from a total of 167 patients infected with non-B HIV subtypes were received
during the study period. Overall 61.7% patients had viral loads of more than 3log copies/ml, suggesting
treatment failure. Among the 72 patients on first line, 56 (77.8%) were resistant to Lamivudine,
57 (79.1%) to Efavirenz and 58 (80.6%) to Nevirapine. Overall, more patients (75.0%) on
first line antiretroviral therapy harbored multi-drug resistance compared to their counterparts on
second line (25.8%).
Conclusion: This study revealed that a group of patients with antiretroviral therapy failure harbored
multi-drug resistance mutations related to the majority of drugs in the first line regimen. Therefore,
HIV resistance testing could be a useful tool to improve HIV care in resource limited settings like
Cameroon where treatment options are limited.