Abstract
Human immunodeficiency virus (HIV) drug resistance (HIVDR) is widespread in sub-Saharan Africa. Children and pregnant women are particularly vulnerable, and laboratory testing capacity remains limited. We, therefore, used a cross-sectional design and convenience sampling to characterize HIV subtypes and resistance-associated mutations (RAMs) in these groups in Sierra Leone. In total, 96 children (age 2–9 years, 100% ART-experienced), 47 adolescents (age 10–18 years, 100% ART-experienced), and 54 pregnant women (>18 years, 72% ART-experienced) were enrolled. Median treatment durations were 36, 84, and 3 months, respectively, while the sequencing success rates were 45%, 70%, and 59%, respectively, among children, adolescents, and pregnant women. Overall, the predominant HIV-1 subtype was CRF02_AG (87.9%, 95/108), with minority variants constituting 12%. Among children and adolescents, the most common RAMs were M184V (76.6%, n = 49/64), K103N (45.3%, n = 29/64), Y181C/V/I (28.1%, n = 18/64), T215F/Y (25.0%, n = 16/64), and V108I (18.8%, n = 12/64). Among pregnant women, the most frequent RAMs were K103N (20.6%, n = 7/34), M184V (11.8%, n = 4/34), Y181C/V/I (5.9%, n = 2/34), P225H (8.8%, n = 3/34), and K219N/E/Q/R (5.9%, n = 2/34). Protease and integrase inhibitor-RAMs were relatively few or absent. Based on the genotype susceptibility score distributions, 73%, 88%, and 14% of children, adolescents, and pregnant women, respectively, were not susceptible to all three drug components of the WHO preferred first-line regimens per 2018 guidelines. These findings suggest that routine HIVDR surveillance and access to better ART choices may improve treatment outcomes in Sierra Leone.
Highlights
According to the World Health Organization (WHO) 2019 report on Human immunodeficiency virus (HIV) drug resistance (HIVDR), the emergence and spread of HIV drug resistance (HIVDR) in low- and middle-income countries (LMICs) was a major factor limiting the success of antiretroviral treatment (ART) programs in achieving the 90–90–90 global targets for 2020 [1]
The WHO report further revealed that children and women are vulnerable, with the prevalence of pre-treatment HIVDR to non-nucleos(t)ide reverse transcriptase inhibitors (NNRTIs) greater than 50% in children aged
The children and adolescents were enrolled at the HIV Clinic at Ola during Children’s Hospital, while the pregnant women were recruited at the HIV and Antenatal Clinic at the Princess Christian Maternity Hospital located in Freetown, Genes 2021, 12, 1314
Summary
According to the World Health Organization (WHO) 2019 report on HIV drug resistance (HIVDR), the emergence and spread of HIVDR in low- and middle-income countries (LMICs) was a major factor limiting the success of antiretroviral treatment (ART) programs in achieving the 90–90–90 global targets for 2020 [1]. The HIV epidemic in the country is described as generalized, with an estimated national HIV prevalence of 1.5% in 2018, i.e., 70,000 people living with HIV, of whom 6600 were children aged 0–14 years [3]. The National AIDS response of Sierra Leone was first launched in 2002— shortly after the country emerged from an 11-year period of civil warfare (1991–2002)—to help combat the growing HIV epidemic. Following the Ebola epidemic of 2014–2016, which led to severe disruptions in HIV service delivery in the country [4,5,6,7], the Government of Sierra Leone announced a five-year National Strategic Plan (NSP) on HIV/AIDS, which aimed to increase routine HIV testing activities, bolster the prevention of mother-to-child transmission (PMTCT) services, and expand ART coverage [8]. The UNAIDS 2019 report revealed that from 2010 to 2018, there was a 27% decrease in AIDS-related deaths and a 22% decline in new HIV infections in the country [3]
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