Abstract
The presence of human immunodeficiency virus (HIV) type-1 diversity has an impact on vaccine efficacy and drug resistance. It is important to know the circulating genetic variants and associated drug-resistance mutations in the context of scale up of antiretroviral therapy (ART) in Nigeria. The objective of this study was to determine the genetic diversity of HIV-1 and the prevalence of antiretroviral (ARV) drug resistance mutations among antiretroviral treatment-naïve HIV-1 infected patients in Jos, North Central Nigeria. Plasma samples were collected from 105 ARV drug-naïve patients enrolled for HIV care at the Jos University Teaching Hospital (JUTH) HIV Treatment Center between October 2010 and April 2011. One hundred (100) samples were successfully amplified. Viral subtyping was done using REGA subtyping tool and by phylogenetic analysis using PAUP software. The drug resistance mutations were determined using the Stanford University HIVdb sequence interpretation algorithm. HIV-1 subtypes identified were; CRF02_AG (48.0%), G (41.0%), CRF06_cpx (6.0%) and A1 (5.0%). 8% of the patients’ isolates had at least one major resistance mutation in the RT gene: Nucleoside reverse transcriptase inhibitors: M41L (1%), K65KR (1%), M184IM (1%), M184V (2%) and T215ADNT (1%), non-nucleoside reverse transcriptase inhibitors: K103N (2%), K101E (1%), G190A (1%), P225HP (1%), Y181I (1%), Y188L (1%), and Y181C (1%). Among antiretroviral (ARV) naïve patients in Jos, North Central Nigeria, the common HIV-1 subtypes was CRF_02 and G. And the prevalence of drug resistance mutations was found to be high (8%). Further study and national surveillance will be critically important to understand the clinical impact of transmitted resistance mutations on ART naïve individuals in resource limited settings. Key words: HIV-1 subtypes, antiretroviral (ARV), treatment-naïve, drug-resistance, mutation, accessory and polymorphisms, Nigeria.
Highlights
Most human immunodeficiency virus type-1 (HIV-1) strains infecting individuals in the Americas, Europe and Australia belong to subtype B, whereas the majority of the remaining viral subtypes are found among persons in sub-Saharan Africa (Robertson et al, 2000)
None of the patients were men who had sex with men (MSM) or injection drug users (IDU). 66% of the participants resided in Plateau state, while 34% resided in other states. 69% were married, 19% were single, while 8% were separated/divorced and 5% were widowed. 11, 22, 36 and 32% of the subjects had no formal education, elementary, secondary and tertiary education respectively
Primary HIV drug resistance represents a challenge for the treatment of HIV infection because it can reduce the efficacy of first-line antiretroviral therapy (ART) and has impact clinical outcomes
Summary
Most human immunodeficiency virus type-1 (HIV-1) strains infecting individuals in the Americas, Europe and Australia belong to subtype B, whereas the majority of the remaining viral subtypes are found among persons in sub-Saharan Africa (Robertson et al, 2000). The use of highly active antiretroviral therapy (HAART) in developed countries has led to a marked reduction in the mortality rate among HIV infected patients. The prevalence of resistant mutations in newly infected individuals range between 10 to 25% in Europe and the Americans (Wensing et al, 2005), while in developing countries like Nigeria, where access to ARVs is increasing, resistance in the treatment-naïve HIV-1 infected is rarely reported (Vergne et al, 2006). Accessory mutations may not result in a significant decrease in sensitivity but are associated with an increase in viral fitness. Given the increasing genetic heterogeneity of HIV1 in West Africa and the increasing use of antiretroviral drugs, it is important to characterize pol gene sequences from HIV-1 subtypes occurring among drug-naive populations. Recent studies have documented that Nigeria has a prevalence of 1.6% in untreated patients (Hamers et al, 2011)
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