The prevalence of resistance-associated mutations to protease and reverse transcriptase inhibitors in treatment-naïve (HIV1)-infected individuals in Casablanca, Morocco

Abstract

Background: The widespread use of antiretroviral agents and the growing occurrence of HIV-1 strains resistant to these drugs have given rise to serious concerns regarding the transmission of resistant viruses to newly infected persons, which may reduce the efficacy of a first-line antiretroviral therapy. Methodology: RNA was extracted from plasma samples of 98 treatment-naïve individuals with a plasma HIV RNA viral load of at least 1,000 copies/ml. Both protease (pr) and reverse transcriptase (rt) were amplified and sequenced using an automated sequencer. National Agency for AIDS Research (ANRS) and Stanford HIV database algorithms were used for interpretation of resistance data. Results: In the protease segment, various minor mutations were present in the majority of the sequenced samples with high frequencies. Only two major mutations, M46L and V82L, were separately found in three individuals of 71 (4.2%) with one carrying both mutations. In the reverse transcriptase gene, no NNRTIs-associated resistance mutations were detected. Only one patient of 70 (1.4%) carried the F77L mutation that is associated with NRTIs resistance. Genetic subtyping revealed that 74.6% of samples were infected with subtype B, 15.5% with CRF02_AG, 4.2% with CRF01_AE, 1.4% with C, 2.8% with G and 1.4% with subtype F2. Conclusions: The low prevalence of major mutations associated with resistance to antiretroviral drugs (ARVs) among drug-naïve individuals studied suggests that the routine of drug resistance testing may be unnecessary for all Moroccan individuals newly diagnosed or all patients beginning antiretroviral therapy. Nevertheless, continuous surveillance is required since greater access to antiretroviral drugs is expected in Morocco.

HIV-1 molecular epidemiology evidence and transmission patterns in the Middle East and North Africa

“…Subtype B was historically also found to be the dominant strain in Morocco, accounting for 93.5% of infections in the 1990s and reflecting transmission pathways of western European origins 20. However, more recent data indicate that although subtype B remains the predominant strain, there is an increasing diversity of HIV-1 variants, with over 25% of the infections being of non-B subtypes, including several CRF 22. In one study from Morocco, 21.4% of the infections were of subtype A and clustered with strains of Kenyan origin 21…”

“…The high population mobility in MENA including migration, tourism, studying and working abroad, and military deployment among others explain in large part the observed pattern of exogenous exposures and subsequent subtype diversity,6 as well as explaining the observed Africanisation of subtypes in some settings 6 9 22 25. Southern Algeria and Morocco are both important migration hubs for migrants from sub-Saharan African countries towards Europe and this is reflected in the high diversity of non-B subtypes and CRF in these regions 9 22.…”

“…Southern Algeria and Morocco are both important migration hubs for migrants from sub-Saharan African countries towards Europe and this is reflected in the high diversity of non-B subtypes and CRF in these regions 9 22. In Turkey, non-B subtype infections are also thought to be mainly caused by immigrants or residents from Africa, the Balkans and the Middle East 29.…”

Genetic diversity and primary resistance among HIV-1-positive patients from Maringá, Paraná, Brazil

“…On the other hand, mutation V82L is a rare mutation selected by tipranavir (TPV), which reduces susceptibility to the drug. The effect of this mutation on other PIs has not been characterized 1 .…”

“…European protocols recommend resistance testing for all treatmentnaïve patients with acute or recent infections, whereas chronically infected patients who require treatment should be tested if the suspicion of resistance is high or if the prevalence of resistance in the population exceeds 10% 1,41 . In Brazil, resistance testing is recommended only for patients undergoing antiretroviral treatment who present virological failure 5 .…”