Evolution of primary HIV drug resistance in a subtype C dominated epidemic in Mozambique.
OBJECTIVE
In Mozambique, highly active antiretroviral treatment (HAART) was introduced in 2004 followed by decentralization and expansion, resulting in a more than 20-fold increase in coverage by 2009. Implementation of HIV drug resistance threshold surveys (HIVDR-TS) is crucial in order to monitor the emergence of transmitted viral resistance, and to produce evidence-based recommendations to support antiretroviral (ARV) policy in Mozambique.


METHODS
World Health Organization (WHO) methodology was used to evaluate transmitted drug resistance (TDR) in newly diagnosed HIV-1 infected pregnant women attending ante-natal clinics in Maputo and Beira to non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI). Subtypes were assigned using REGA HIV-1 subtyping tool and phylogenetic trees constructed using MEGA version 5.


RESULTS
Although mutations associated with resistance to all three drug were detected in these surveys, transmitted resistance was analyzed and classified as <5% in Maputo in both surveys for all three drug classes. Transmitted resistance to NNRTI in Beira in 2009 was classified between 5-15%, an increase from 2007 when no NNRTI mutations were found. All sequences clustered with subtype C.


CONCLUSIONS
Our results show that the epidemic is dominated by subtype C, where the first-line option based on two NRTI and one NNRTI is still effective for treatment of HIV infection, but intermediate levels of TDR found in Beira reinforce the need for constant evaluation with continuing treatment expansion in Mozambique.
Instituto Nacional de Saúde, Maputo, Mozambique ; Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro,Rio de Janeiro, Brazil. dulcebila@gmail.com
Dulce Celina Adolfo
DC
Bila
Peter
P
Young
Harriet
H
Merks
Adolfo Salvador
AS
Vubil
Mussagy
M
Mahomed
Angelo
A
Augusto
Celina Monteiro
CM
Abreu
Nédio Jonas
NJ
Mabunda
James I
JI
Brooks
Amilcar
A
Tanuri
Ilesh Vinodrai
IV
Jani
D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1 / Q000145:classification / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D009154:Mutation; D010802:Phylogeny; D011247:Pregnancy; D055815:Young Adult
D019380:Anti-HIV Agents