title: High level of HIV-1 drug resistance among patients with HIV-1 and HIV-1/2 dual infections in Guinea-Bissau.
abstract: BACKGROUND
  With the widespread use of antiretroviral treatment (ART) in Africa, the risk of drug resistance has increased. The aim of this study was to evaluate levels of HIV-1 resistance among patients with HIV-1 and HIV-1/2 dual infections, treated with ART, at a large HIV clinic in Guinea-Bissau.
  
  
  RESULTS
  Patients were selected from the Bissau HIV cohort. All patients had HIV-1 or HIV-1/2 dual infection, a CD4 cell count performed before and 3-12 months after starting ART, and a corresponding available plasma sample. We measured viral load in patients with HIV-1 (n = 63) and HIV-1/2 dual (n = 16) infections a median of 184 days after starting ART (IQR: 126-235 days). In patients with virological failure (defined as viral load >1000 copies/ml) and with sufficient plasma available, we performed an HIV-1 genotypic resistance test. Thirty-six patients (46%) had virological failure. The CD4 cell count did not predict treatment failure. Of the 36 patients with virological failure, we performed a resistance test in 15 patients (42%), and nine patients (9/15; 60%) had resistance mutations. The most common mutation was K103N, which confers high-level resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI). No major mutations against protease inhibitors (PI) were found.
  
  
  CONCLUSIONS
  Our results showed that patients with HIV-1 and HIV-1/2 dual infections in Guinea-Bissau had a high rate of virological failure and rapid development of NNRTI resistance. It remains to be determined whether a more robust, PI-based treatment regimen might benefit this population more than NNRTIs.
authors.affiliation: Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau. sanne.jespersen@clin.au.dk.|Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. sanne.jespersen@clin.au.dk.
authors.forename: Sanne
authors.initials: S
authors.lastname: Jespersen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. marttols@rm.dk.
authors.forename: Martin
authors.initials: M
authors.lastname: Tolstrup
authors.affiliation: Bandim Health Project, Indepth Network, Apartado 861, Bissau, Guinea-Bissau. bohonge@gmail.com.|Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. bohonge@gmail.com.|Department of Clinical Immunology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. bohonge@gmail.com.
authors.forename: Bo Langhoff
authors.initials: BL
authors.lastname: Hønge
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, CP 1013, Bissau, Guinea-Bissau. candidamedina2@yahoo.com.br.
authors.forename: Candida
authors.initials: C
authors.lastname: Medina
authors.affiliation: National HIV Programme, Ministry of Health, Bissau, CP 1013, Bissau, Guinea-Bissau. daviddasilvate@gmail.com.
authors.forename: David da Silva
authors.initials: Dda S
authors.lastname: Té
authors.affiliation: Department of Clinical Microbiology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. svenelle@rm.dk.
authors.forename: Svend
authors.initials: S
authors.lastname: Ellermann-Eriksen
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. larsoest@rm.dk.
authors.forename: Lars
authors.initials: L
authors.lastname: Østergaard
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. wejse@dadlnet.dk.|GloHAU, Center for Global Health, School of Public Health, Aarhus University, Bartholins Allé 2, 8000, Aarhus C, Denmark. wejse@dadlnet.dk.
authors.forename: Christian
authors.initials: C
authors.lastname: Wejse
authors.affiliation: Department of Infectious Diseases, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200, Aarhus N, Denmark. alexlaur@rm.dk.
authors.forename: Alex Lund
authors.initials: AL
authors.lastname: Laursen
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D060085:Coinfection / Q000188:drug therapy* / Q000821:virology; D024882:Drug Resistance, Viral; D005260:Female; D006169:Guinea-Bissau; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D015498:HIV-2 / Q000187:drug effects* / Q000235:genetics / Q000502:physiology; D006801:Humans; D008297:Male
chemical_list: D019380:Anti-HIV Agents