Threshold survey evaluating transmitted HIV drug resistance among public antenatal clinic clients in Addis Ababa, Ethiopia.
BACKGROUND
Expanded access to HIV therapy in the developing world raises serious concerns regarding the potential emergence and transmission of drug-resistant HIV strains. Although HIV drug resistance surveillance is recommended to track transmitted HIV drug resistance among newly infected individuals, the financial constraints in resource-limited countries prohibit such surveillance on a regular basis. The World Health Organization (WHO) recently introduced guidelines to address this issue.


METHODS
A survey was conducted in Ethiopia following the WHO guidelines to assess transmitted HIV drug resistance among recently HIV-infected individuals in Addis Ababa. Antiretroviral drug usage started 3 years earlier than commencement of the current expanded access to antiretroviral therapy in Ethiopia.


RESULTS
Of 75 eligible samples, 39 (52%) were successfully sequenced and genotyped in the protease and reverse transcriptase region, using both the ViroSeq and TrueGene genotyping systems, and analysed for drug resistance mutations using an algorithm from the Stanford HIV Reverse Transcriptase and Protease Database. The analysis revealed that transmitted HIV drug resistance in Addis Ababa is below the 5% threshold level for all three classes of antiretrovirals.


CONCLUSIONS
The current first-line antiretroviral therapy strategy can be used with confidence in Ethiopia at this time; however, Ethiopia should conduct similar periodic surveys that include the capitals of Ethiopia's larger regional states to ensure early detection of any changes in the country's HIV drug resistance trend.
Abegaz
Woldaregay Erku
WE
Aklilu Lemma Institute of Pathobiology, Addis Ababa University, Ethiopia. woldaregay_e@yahoo.com
Grossman
Zehava
Z
Wolday
Dawit
D
Ram
Daniela
D
Kaplan
Jonathan
J
Sibide
Kassim
K
Wuhib
Tadesse
T
Ismael
Shabbir
S
Nkengasong
John
J
Mekonen
Teferi
T
Berhanu
Hiwot
H
Messele
Tsehaynesh
T
Lulseged
Sileshi
S
Maayan
Shlomo
S
Mengistu
Yohannes
Y
D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D004252:DNA Mutational Analysis; D030541:Databases, Genetic; D024882:Drug Resistance, Viral / Q000235:genetics*; D005002:Ethiopia / Q000453:epidemiology; D005260:Female; D005838:Genotype; D006678:HIV / Q000201:enzymology / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D006801:Humans; D009313:National Health Programs / Q000706:statistics & numerical data; D011247:Pregnancy; D011295:Prenatal Care / Q000706:statistics & numerical data; D015397:Program Evaluation; D017150:Public Sector / Q000706:statistics & numerical data; D018571:Sentinel Surveillance; D016896:Treatment Outcome; D014944:World Health Organization
D044966:Anti-Retroviral Agents; D054303:HIV Reverse Transcriptase; D016333:HIV Protease