title: HIV-1 genetic diversity and transmitted drug resistance mutations among patients from the North, Central and South regions of Angola.
abstract: BACKGROUND
  Angola presents a very complex HIV-1 epidemic characterized by the co-circulation of several HIV-1 group M subtypes, intersubtype recombinants and unclassified (U) variants. The viral diversity outside the major metropolitan regions (Luanda and Cabinda) and the prevalence of transmitted drug resistance mutations (DRM) since the introduction of HAART in 2004, however, has been barely studied.
  
  
  METHODS
  One hundred and one individuals from the Central (n = 44), North (n = 35), and South (n = 22) regions of Angola were diagnosed as HIV-1 positive and had their blood collected between 2008 and 2010, at one of the National Referral Centers for HIV diagnosis, the Kifangondo Medical Center, located in the border between the Luanda and Bengo provinces. Angolan samples were genotyped based on phylogenetic and bootscanning analyses of the pol (PR/RT) gene and their drug resistance profile was analyzed.
  
  
  RESULTS
  Among the 101 samples analyzed, 51% clustered within a pure group M subtype, 42% were classified as intersubtype recombinants, and 7% were denoted as U. We observed an important variation in the prevalence of different HIV-1 genetic variants among country regions, with high frequency of subtype F1 in the North (20%), intersubtype recombinants in the Central (42%), and subtype C in the South (45%). Statistically significant difference in HIV-1 clade distribution was only observed in subtype C prevalence between North vs South (p = 0.0005) and Central vs South (p = 0.0012) regions. DRM to NRTI and/or NNRTI were detected in 16.3% of patients analyzed.
  
  
  CONCLUSIONS
  These results demonstrate a heterogeneous distribution of HIV-1 genetic variants across different regions in Angola and also revealed an unexpected high frequency of DRM to RT inhibitors in patients that have reported no antiretroviral usage, which may decrease the efficiency of the standard first-line antiretroviral regimens currently used in the country.
authors.affiliation: Laboratorio de AIDS & Imunologia Molecular, Instituto Oswaldo Cruz-FIOCRUZ, Rio de Janeiro, Brazil. jmafonso.7@gmail.com
authors.forename: Joana Morais
authors.initials: JM
authors.lastname: Afonso
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Bello
authors.forename: Monick L
authors.initials: ML
authors.lastname: Guimarães
authors.forename: Marta
authors.initials: M
authors.lastname: Sojka
authors.forename: Mariza G
authors.initials: MG
authors.lastname: Morgado
mesh_terms: D000328:Adult; D000810:Angola; D019380:Anti-HIV Agents / Q000494:pharmacology*; D002469:Cell Separation; D004351:Drug Resistance; D024882:Drug Resistance, Viral; D005260:Female; D005434:Flow Cytometry; D014644:Genetic Variation; D005838:Genotype; D005843:Geography; D015658:HIV Infections / Q000188:drug therapy* / Q000235:genetics*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008297:Male; D009154:Mutation; D010802:Phylogeny; D016133:Polymerase Chain Reaction / Q000379:methods; D015995:Prevalence; D011995:Recombination, Genetic
chemical_list: D019380:Anti-HIV Agents