title: Short Communication: Population-Based Surveillance of HIV-1 Drug Resistance in Cameroonian Adults Initiating Antiretroviral Therapy According to the World Health Organization Guidelines.
abstract: With ongoing earlier enrollment on and rapid scale-up of antiretroviral therapy (ART) in Cameroon, there are increasing risks of transmitted HIV drug resistance (HIVDR) at population levels. We, therefore, evaluated the threshold of HIVDR in a population initiating ART, to inform on the effectiveness of first-line regimens, considering HIV-1 diversity, plasma viral load (PVL), and CD4-based disease progression. A total of 53 adults [median (interquartile range, IQR) CD4: 162 cell/mm(3) (48-284); median (IQR) PVL: 5.34 log10 RNA (4.17-6.42) copies/ml] initiating ART in 2014 at the Yaoundé Central Hospital were enrolled for HIV-1 protease-reverse transcriptase sequencing. Drug resistance mutations (DRMs) were interpreted using the 2009 World Health Organization (WHO) list versus the Stanford HIVdb algorithm version 7.0. Level of DRMs was low (3.77%) versus moderate (7.55%), respectively, following the WHO list (T69D, K103N) versus Stanford HIVdb (T69D, A98G, K103N, K238T), respectively. Prevailing clade was CRF02_AG (71.70%). Based on Stanford HIVdb, a slightly higher proportion of patients with DRMs were found among ones infected with CRF02_AG than in those non-CRF02_AG infected (7.89% vs. 6.67%, p = 1.000), with lower PVL (7.69% <5.5 vs. 0% ≥5.5 log10 RNA copies/ml, p = .488) and with higher CD4 counts (9.52% CD4 ≥200 vs. 3.33% CD4 <200 cells/mm(3), p = .749). Thresholds of DRMs suggest that standard first-line regimens currently used in Cameroon may remain effective at population levels, despite scale-up of ART in the country, pending adherence, and closed virological monitoring. With an intent-to-diagnose approach, the discrepant levels of DRMs support using Stanford HIVdb to evaluate initial ART, while revising the WHO list for surveillance.
authors.affiliation: 1 Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management , Yaoundé, Cameroon .|2 University of Rome Tor Vergata , Rome, Italy .|3 Faculty of Medicine and Biomedical Sciences, University of Yaoundé I , Yaoundé, Cameroon .|4 National HIV Drug Resistance Prevention and Surveillance Working Group, Ministry of Public Health , Yaoundé, Cameroon .
authors.forename: Joseph
authors.initials: J
authors.lastname: Fokam
authors.affiliation: 1 Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management , Yaoundé, Cameroon .
authors.forename: Désiré
authors.initials: D
authors.lastname: Takou
authors.affiliation: 2 University of Rome Tor Vergata , Rome, Italy .
authors.forename: Maria Mercedes
authors.initials: MM
authors.lastname: Santoro
authors.affiliation: 3 Faculty of Medicine and Biomedical Sciences, University of Yaoundé I , Yaoundé, Cameroon .
authors.forename: Haniel Ze
authors.initials: HZ
authors.lastname: Akonie
authors.affiliation: 5 HIV Care and Treatment Centre, Yaoundé Central Hospital , Yaoundé, Cameroon .
authors.forename: Charles
authors.initials: C
authors.lastname: Kouanfack
authors.affiliation: 2 University of Rome Tor Vergata , Rome, Italy .
authors.forename: Francesca
authors.initials: F
authors.lastname: Ceccherini-Silberstein
authors.affiliation: 1 Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management , Yaoundé, Cameroon .|2 University of Rome Tor Vergata , Rome, Italy .
authors.forename: Vittorio
authors.initials: V
authors.lastname: Colizzi
authors.affiliation: 1 Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management , Yaoundé, Cameroon .|2 University of Rome Tor Vergata , Rome, Italy .|6 National Institute for Infectious Diseases "Lazzaro Spallanzani ," Rome, Italy .
authors.forename: Carlo-Federico
authors.initials: CF
authors.lastname: Perno
authors.affiliation: 1 Chantal BIYA International Reference Centre for Research on HIV/AIDS Prevention and Management , Yaoundé, Cameroon .|3 Faculty of Medicine and Biomedical Sciences, University of Yaoundé I , Yaoundé, Cameroon .
authors.forename: Alexis
authors.initials: A
authors.lastname: Ndjolo
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D002163:Cameroon / Q000453:epidemiology; D024882:Drug Resistance, Viral; D062665:Epidemiological Monitoring; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000821:virology*; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D008297:Male; D020125:Mutation, Missense; D015995:Prevalence; D011446:Prospective Studies; D017422:Sequence Analysis, DNA; D014944:World Health Organization
chemical_list: D044966:Anti-Retroviral Agents; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase; D016333:HIV Protease; C514803:p16 protease, Human immunodeficiency virus 1