HIV Genetic Diversity in Cameroon: Possible Public Health Importance

Abstract

To monitor the evolving molecular epidemiology and genetic diversity of HIV in a country where many distinct strains cocirculate, we performed genetic analyses on sequences from 75 HIV-1-infected Cameroonians: 74 were group M and 1 was group O. Of the group M sequences, 74 were classified into the following env gp41 subtypes or recombinant forms: CRF02 (n ‫؍‬ 54), CRF09 (n ‫؍‬ 2), CRF13 (n ‫؍‬ 2), A (n ‫؍‬ 5), CRF11 (n ‫؍‬ 4), CRF06 (n ‫؍‬ 1), G (n ‫؍‬ 2), F2 (n ‫؍‬ 2), and E (n ‫؍‬ 1, CRF01), and 1 was a JG recombinant. Comparison of phylogenies for 70 matched gp41 and protease sequences showed inconsistent classifications for 18 (26%) strains. Our data show that recombination is rampant in Cameroon with recombinant viruses continuing to recombine, adding to the complexity of circulating HIV strains. This expanding genetic diversity raises public health concerns for the ability of diagnostic assays to detect these unique HIV mosaic variants and for the development of broadly effective HIV vaccines.

Alternative Algorithms for Human Immunodeficiency Virus Infection Diagnosis Using Tests That Are Licensed in the United States

“…Of the 621 positive sera, there were 128 sera from donors infected with non-B subtypes (25). These were initially intended to separately evaluate test performance on non-B subtypes.…”

“…Specimens from infected and uninfected U.S. blood/ plasma donors (n ϭ 997) and from international donors (n ϭ 64) were obtained from BBI-SeraCare Diagnostics (West Bridgewater, MA). An additional 114 specimens were obtained from a CDC study conducted in Cameroon (25). Most of the international plasma samples (128 of 178) were from subjects infected with non-subtype-B HIV-1 as determined by genotyping, and the rest were negative or indeterminate for HIV infection.…”

Molecular Characterization of Human Immunodeficiency Virus Type 1 (HIV-1) and HIV-2 in Yaoundé, Cameroon: Evidence of Major Drug Resistance Mutations in Newly Diagnosed Patients Infected with Subtypes Other than Subtype B

“…Unlike the case in southern and eastern African countries, where one or two HIV-1 subtypes dominate (22), all major groups and subtypes of HIV-1 cocirculate in Cameroon (1, 6, 14-19, 21, 22, 24, 28, 34-38). According to WHO/UNAIDS, as of the end of 2004, the prevalence of HIV-1 infection was estimated to be 4.8% overall and 9.8% for adults.…”

Performance evaluation of an in-house human immunodeficiency virus type-1 protease-reverse transcriptase genotyping assay in Cameroon

“…[5] Although patients in Cameroon have been receiving free highly active antiretroviral therapy (HAART) since 2007, the management of HIV infection within the health care system is still of poor quality due to insufficient and generic treatment guidelines, financial restrictions to individual patient follow-up and setbacks in diagnostics due to the high viral genetic variability [8,9]. Cameroon is a setting where all of the known groups of HIV-1, the rare group O (Outlier), group N (Non-O, Non-M), and the recent group P, have been identified from people with epidemiologic links to this country [10][11][12]. Therefore, this country is a field setting with features that are suitable for assessing the performance of a genotyping tool that could be useful for HIV-1 GRT at an affordable cost, in order to improve the management of infected patients in health systems with similar characteristics.…”