title: Description of HIV-1 group M molecular epidemiology and drug resistance prevalence in Equatorial Guinea from migrants in Spain.
abstract: BACKGROUND
  The HIV epidemic is increasing in Equatorial Guinea (GQ), West Central Africa, but few studies have reported its HIV molecular epidemiology. We aimed to describe the HIV-1 group M (HIV-1M) variants and drug-resistance mutations in GQ using sequences sampled in this country and in Spain, a frequent destination of Equatoguinean migrants.
  
  
  METHODS
  We collected 195 HIV-1M pol sequences from Equatoguinean subjects attending Spanish clinics during 1997-2011, and 83 additional sequences sampled in GQ in 1997 and 2008 from GenBank. All (n = 278) were re-classified using phylogeny and tested for drug-resistance mutations. To evaluate the origin of CRF02_AG in GQ, we analyzed 2,562 CRF02_AG sequences and applied Bayesian MCMC inference (BEAST program).
  
  
  RESULTS
  Most Equatoguinean patients recruited in Spain were women (61.1%) or heterosexuals (87.7%). In the 278 sequences, the variants found were CRF02_AG (47.8%), A (13.7%), B (7.2%), C (5.8%), G (5.4%) and others (20.1%). We found 6 CRF02_AG clusters emerged from 1983.9 to 2002.5 with origin in GQ (5.5 sequences/cluster). Transmitted drug-resistance (TDR) rate among naïve patients attended in Spain (n = 144) was 4.7%: 3.4% for PI (all with M46IL), 1.8% for NRTI (all with M184V) and 0.9% for NNRTI (Y188L). Among pre-treated patients, 9/31 (29%) presented any resistance, mainly affecting NNRTI (27.8%).
  
  
  CONCLUSIONS
  We report a low (<5%) TDR rate among naïve, with PI as the most affected class. Pre-treated patients also showed a low drug-resistance prevalence (29%) maybe related to the insufficient treatment coverage in GQ. CRF02_AG was the prevalent HIV-1M variant and entered GQ through independent introductions at least since the early 1980s.
authors.affiliation: HIV-1 Molecular Epidemiology Laboratory, Dept. of Microbiology, Hospital Ramón y Cajal-IRYCIS and CIBERESP, Madrid, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Yebra
authors.forename: Miguel
authors.initials: M
authors.lastname: de Mulder
authors.forename: África
authors.initials: Á
authors.lastname: Holguín
mesh_terms: D019380:Anti-HIV Agents / Q000627:therapeutic use*; D016000:Cluster Analysis; D024882:Drug Resistance, Viral / Q000235:genetics; D016703:Equatorial Guinea / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology*; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D016013:Likelihood Functions; D008297:Male; D017720:Molecular Epidemiology; D015995:Prevalence; D013030:Spain / Q000208:ethnology; D014171:Transients and Migrants
chemical_list: D019380:Anti-HIV Agents