Characterization of drug resistance in antiretroviral-treated patients infected with HIV-1 CRF02_AG and AGK subtypes in Mali and Burkina Faso.
BACKGROUND
In a multicentred cohort of patients on antiretroviral therapy (ART) in Burkina Faso and Mali, we analysed the prevalence of HIV drug resistance mutations in patients failing a modified directly observed therapy (mDOT) protocol.


METHODS
Patients on ART >6 months and with viral load (VL) >500 copies/ml were enrolled in a mDOT protocol. Genotypic resistance testing was performed on pre- and post-mDOT plasma samples of patients who still had VL >500 copies/ml after mDOT.


RESULTS
Eight hundred and one patients from seven sites participated in the study. One hundred and thirteen patients (14.1%) had VL >500 copies/ml. Most patients were treated with lamivudine along with zidovudine or stavudine and efavirenz or nevirapine. Genotypes were available for 46 patients. The predominant HIV-1 subtypes were CRFO2_AG in 26 (56.5%) and AGK/K/AK in 12 (26.1%) patients. The prevalence of drug resistance mutations by class were as follows for nucleoside reverse transcriptase inhibitors: 1841/V (82.6%), 215Y/F (32.6%), 219E/Q (19.6%), 70R (19.6%), 67N (21.7%), 41L (15.2%) and 151M(2.2%). For non-nucleoside reverse transcriptase inhibitors the prevalence was: 103N (50%) and 181C/I (19.6%). Phylogenetic analysis showed that, although the genetic distances were small among isolates, there was no clustering of a particular subtype in a specific region and that the high prevalence of AGK subtype in our drug-resistant population was not due to a circulating resistant strain.


CONCLUSIONS
Although CRFO2_AG is the dominant clade in the Burkina Faso/Mali region, isolates with subtype K reverse transcriptase were frequent in our cohort. Drug resistance mutation pathways in subtype K reverse transcriptase need to be further evaluated in a larger cohort of non-B HIV-infected individuals.
Sylla
Mohamed
M
Département de Microbiologie et Immunologie, Université de Montréal, Montréal, Canada.
Chamberland
Annie
A
Boileau
Catherine
C
Traoré
Hamar A
HA
Ag-Aboubacrine
Souleyman
S
Cissé
Mamadou
M
Koala
Samual
S
Drabo
Joseph
J
Diallo
Ismael
I
Niamba
Pascal
P
Tremblay-Sher
Daniel
D
Machouf
Nimâ
N
Rashed
Sélim
S
Nickle
David C
DC
Nguyen
Vinh-Kim
VK
Tremblay
Cécile L
CL
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D002050:Burkina Faso / Q000453:epidemiology; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008297:Male; D008302:Mali / Q000453:epidemiology; D009154:Mutation; D010802:Phylogeny
D019380:Anti-HIV Agents