Evolution of Primary HIV Drug Resistance in a Subtype C Dominated Epidemic in Mozambique

Abstract

ObjectiveIn Mozambique, highly active antiretroviral treatment (HAART) was introduced in 2004 followed by decentralization and expansion, resulting in a more than 20-fold increase in coverage by 2009. Implementation of HIV drug resistance threshold surveys (HIVDR-TS) is crucial in order to monitor the emergence of transmitted viral resistance, and to produce evidence-based recommendations to support antiretroviral (ARV) policy in Mozambique.MethodsWorld Health Organization (WHO) methodology was used to evaluate transmitted drug resistance (TDR) in newly diagnosed HIV-1 infected pregnant women attending ante-natal clinics in Maputo and Beira to non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI). Subtypes were assigned using REGA HIV-1 subtyping tool and phylogenetic trees constructed using MEGA version 5.ResultsAlthough mutations associated with resistance to all three drug were detected in these surveys, transmitted resistance was analyzed and classified as <5% in Maputo in both surveys for all three drug classes. Transmitted resistance to NNRTI in Beira in 2009 was classified between 5–15%, an increase from 2007 when no NNRTI mutations were found. All sequences clustered with subtype C.ConclusionsOur results show that the epidemic is dominated by subtype C, where the first-line option based on two NRTI and one NNRTI is still effective for treatment of HIV infection, but intermediate levels of TDR found in Beira reinforce the need for constant evaluation with continuing treatment expansion in Mozambique.

Molecular Epidemiology of HIV-1 Infected Migrants Followed Up in Portugal: Trends between 2001–2017

“…Between 2010 and 2017, EFV and 3TC were recommended for first line treatment in Portugal. This was also the most frequent NRTI and NNRTI-resistance mutation (M184V and K103N) among pre-treated patients and was previously reported among antiretroviral-naïve patients living in Portuguese Speaking countries [38,40,41]. A low prevalence of TDR to PIs within migrants reflects the scarce administration of this antiretroviral as first line in their countries of origin.…”

“…Among migrants from different Portuguese-speaking countries, migrants from Mozambique showed a high resistance rate of 17.4%, compared to the average of other Portuguese-speaking countries analyzed herein (7-10%). These results are discordant with other studies involving patients from Mozambique between the years 2007 and 2009 that showed a low prevalence of 5% of primary drug resistance based on WHO mutation list [37,38]. These differences may be related to four hypotheses: 1) The rate of TDR involving increased, since the studies conducted in this area are older.…”

Recombinant NAD-dependent SIR-2 Protein of Leishmania donovani: Immunobiochemical Characterization as a Potential Vaccine against Visceral Leishmaniasis

“…File was then converted to MEGA file format and using MEGA file format phylogenetic tree was built using MEGA 5.2 tool, using Maximum Parsimony approach [ 23 ]. Tool has been previous cited in other research articles [ 24 – 26 ] for constructing Phylogenetic tree. Given sequences were then uploaded in GLAM2 tool [ 27 ] of MEME suite [ 28 ] to identify motifs present in group of related protein sequences.…”

Pooled Nucleic Acid Testing to Detect Antiretroviral Treatment Failure in HIV-Infected Patients in Mozambique

“…Further, virological monitoring maybe an urgent need given that in the capital Maputo, a transmitted drug resistance rate of <5% was calculated from multiple surveys[18]. We were especially interested in further validating a pooled qualitative PCR assay in Mozambique that would allow for subsequent genotyping to assess for drug resistance in cases of virologic failure[12].…”