Abstract
As more HIV patients start combination antiretroviral therapy (cART), the emergence of HIV drug resistance (HIVDR) is inevitable. This will have consequences for the transmission of HIVDR, the success of ART, and the nature and trend of the epidemic. We recruited a cohort of 223 patients starting or continuing their first-line cART in Tanzania towards the end of the stavudine era in 2010. Patients were then followed for one year. Of those with a viral load test at baseline and follow-up time, 34% had a detectable viral load at the one-year endpoint. For 41 patients, protease and reverse transcriptase genotyping were successful. Eighteen samples were from cART-naïve patients, and 23 samples were taken under therapy either at baseline for cART-experienced patients or from follow-up samples for both cART–naïve and cART–experienced patients. The isolates were subtype A, followed by C and D in 41.5%, 22%, and 12.2% of the patients, respectively. No transmitted HIVDR was detected, as scored using the surveillance drug resistance mutations (DRMs) list. However, in 3 of the 18 samples from cART-naïve patients, the clinical Rega interpretation algorithm scored 44D or 138A as non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance-associated polymorphisms. The most observed nucleoside reverse transcriptase inhibitor (NRTI) mutation was 184V. The mutation was found in 16 patients, causing resistance to lamivudine and emtricitabine. Nineteen patients had NNRTI resistance mutations, the most common of which was 103N, observed in eight patients. These high levels of resistance call for regular drug resistance surveillance in Tanzania to inform the control of the emergence and transmission of HIVDR.
Highlights
The recent scale-up of combination antiretroviral therapy in resource-limited settings (RLS) has significantly reduced morbidity and mortality among HIV and AIDSMicrobiol
Among the few ARVs that are available in such settings, a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) is used as the first-line regimen [1]
The design of the study was prospective, the failure to obtain a genotype for 50% of our viral-load positive samples and successes heavily biased towards samples with higher viral load means that we can merely report on the resistance evolution found
Summary
The recent scale-up of combination antiretroviral therapy (cART) in resource-limited settings (RLS) has significantly reduced morbidity and mortality among HIV and AIDSMicrobiol. The recent scale-up of combination antiretroviral therapy (cART) in resource-limited settings (RLS) has significantly reduced morbidity and mortality among HIV and AIDS. The success of these programs stems from the population-based approach to provide affordable and simplified standard first- and second-line regimens recommended by the World Health Organization (WHO). Among the few ARVs that are available in such settings, a combination of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleoside reverse transcriptase inhibitor (NNRTI) is used as the first-line regimen [1]. The WHO recommendations included a more potent dolutegravir (DTG)
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