title: HIV-1 drug resistance-associated mutations among HIV-1 infected drug-naïve antenatal clinic attendees in rural Kenya.
abstract: BACKGROUND
  Access to antiretroviral therapy (ART) has increased dramatically in Sub-Saharan Africa. In Kenya, 560,000 people had access to ART by the end of 2011. This scaling up of ART has raised challenges to the Kenyan health system due to emergence of drug resistant viruses among those on treatment and possible onward transmission. To counter this, and come up with an effective treatment strategy, it has become vital to determine baseline mutations associated with drug resistance among the circulating strains of HIV-1 in Kenya.
  
  
  METHODS
  The prevalence of mutations associated with drug resistance in HIV-1 protease (PR) and reverse transcriptase (RT) regions from 188 HIV-1 infected treatment-naïve pregnant women was investigated in Kapsabet, Nandi Hills and Kitale district hospitals of Kenya. Blood samples were collected between April 2005 and June 2006. The HIV-1 pol gene was amplified using primers for HIV-1 PR and RT and sequenced using the BigDye chemistry. The mutations were analyzed based on the IAS algorithm as well as the Stanford University HIV Drug Resistance Database.
  
  
  RESULTS
  Based on the PR and RT sequences, HIV-1 subtypes A1 (n=117, 62.2%), A2 (n=2, 1.1%), D (n=27, 14.4%), C (n=13, 6.9%), G (n=3, 1.6%), and possible recombinants (n=26, 13.8%) were detected. Mutations associated with nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside RTI (NNRTI)-resistance were detected in 1.6% (3 of 188) and 1.1% (2 of 188), respectively. Mutations associated with PI resistance were detected in 0.5% (1 of 188) of the study population.
  
  
  CONCLUSIONS
  The prevalence of drug resistance among drug-naïve pregnant women in rural North Rift, Kenya in 2006 was 3.2%. Major drug resistance mutations associated with PIs, NRTIs and NNRTIs do exist among treatment-naïve pregnant women in North Rift, Kenya. There is a need for consistent follow-up of drug-naïve individuals in this region to determine the impact of mutations on treatment outcomes.
authors.affiliation: Centre for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya. Mkiptoo@kemri.org.
authors.forename: Michael
authors.initials: M
authors.lastname: Kiptoo
authors.forename: James
authors.initials: J
authors.lastname: Brooks
authors.forename: Raphael W
authors.initials: RW
authors.lastname: Lihana
authors.forename: Paul
authors.initials: P
authors.lastname: Sandstrom
authors.forename: Zipporah
authors.initials: Z
authors.lastname: Ng'ang'a
authors.forename: Joyceline
authors.initials: J
authors.lastname: Kinyua
authors.forename: Nancy
authors.initials: N
authors.lastname: Lagat
authors.forename: Fredrick
authors.initials: F
authors.lastname: Okoth
authors.forename: Elijah M
authors.initials: EM
authors.lastname: Songok
mesh_terms: D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D007630:Kenya / Q000453:epidemiology; D008969:Molecular Sequence Data; D009154:Mutation / Q000235:genetics*; D011247:Pregnancy; D011251:Pregnancy Complications, Infectious / Q000821:virology; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology; D012424:Rural Population; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D018894:Reverse Transcriptase Inhibitors; D054302:pol Gene Products, Human Immunodeficiency Virus