Evidence of HIV-1 Genital Shedding after One Year of Antiretroviral Therapy in Females Recently Diagnosed in Bamako, Mali.

Abdelaye Keita,Josselin Rigaill,Souleymane Coulibaly,Fodé Diallo,Bruno Pozzetto,Thomas Bourlet,Tenin Aoua Thiero,Paul Verhoeven,Sylvie Pillet,Youssouf Sereme

doi:10.3390/microorganisms9102164

Abstract

Little is known about the dynamic of HIV-1 shedding and resistance profiles in the female genital reservoir after antiretroviral therapy (ART) initiation in resource-limited countries (RLCs), which is critical for evaluating the residual sexual HIV-1 transmission risk. The present study aimed to evaluate the efficacy of 1 year duration ART at blood and genital levels in females newly diagnosed for HIV-1 from three centers in Bamako, Mali. Seventy-eight consenting females were enrolled at the time of their HIV-1 infection diagnosis. HIV-1 RNA loads (Abbott Real-Time HIV-1 assay) were tested in blood and cervicovaginal fluids (CVF) before and 12 months after ART initiation. Primary and acquired resistances to ART were evaluated by ViroseqTM HIV-1 genotyping assay. The vaginal microbiota was analyzed using IonTorrentTM NGS technology (Thermo Fisher Scientific). Proportions of primary drug resistance mutations in blood and CVF were 13.4% and 25%, respectively. Discrepant profiles were observed in 25% of paired blood/CVF samples. The acquired resistance rate was 3.1% in blood. At month 12, undetectable HIV-1 RNA load was reached in 84.6% and 75% of blood and CVF samples, respectively. A vaginal dysbiosis was associated with HIV RNA shedding. Our findings emphasize the need of reinforcing education to improve retention in care system, as well as the necessity of regular virological monitoring before and during ART and of implementing vaginal dysbiosis diagnosis and treatment in RLCs.

Highlights

We described a high prevalence of pretreatment drug resistance mutations (PDRMs) in the blood of people newly diagnosed for HIV-1 in Bamako, Mali, associated with a reassuring virological success rate, as well as a low level of acquired mutations in combined antiretroviral treatment (cART)-adherent people [17]
antiretroviral therapy (ART) was initiated in all participants within 2 weeks of HIV diagnosis, combining either two nucleosidic reverse transcriptase inhibitors (NRTIs) and one NNRTI or two NRTIs and one protease inhibitor (PI) in 95.8%
Our work aimed to quantify the viral shedding in cervicovaginal fluids (CVF) before and after 12 months of first-line ART in females newly diagnosed positive for HIV-1 in Bamako

Summary

Introduction

In 2016, the United Nations approved the 95/95/95 treatment targets with the aim of ending the HIV/AIDS epidemic by 2030 [1]. To this end, 95% of people living with. HIV (PLWH), 95% of diagnosed people under combined antiretroviral treatment (cART), and 95% of people under treatment with fully suppressed viral load (VL) are the goals to reach. In this context, the initiation of cART in all PLWH at any CD4+ T-cell count has been recommended by the World Health Organization (WHO) since 2015 [2].

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