HIV Drug Resistance Testing in a Resource Limited Setting with High Viral Diversity: The First Twenty Eight Months Experience

Author(s): Elodie Teclaire Ngo-Malabo, Paul Alain Ngoupo, Serge Alain Sadeuh-Mba, Emmanuel Akongnwi, Robert Banaï, Laure Ngono, Charles Felix Bilong-Bilong, Anfumbom Kfutwah, Richard Njouom*.

Journal Name: Current HIV Research

Volume 15 , Issue 4 , 2017

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Abstract:

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.

Keywords: Treatment failure, HIV, genotyping resistance test, mutation, drug resistance, resource limited setting, Cameroon, Viral Diversity.

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Article Details

VOLUME: 15
ISSUE: 4
Year: 2017
Page: [297 - 305]
Pages: 9
DOI: 10.2174/1570162X15666170725143835
Price: $58

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