Abstract
ObjectiveIn Mozambique, highly active antiretroviral treatment (HAART) was introduced in 2004 followed by decentralization and expansion, resulting in a more than 20-fold increase in coverage by 2009. Implementation of HIV drug resistance threshold surveys (HIVDR-TS) is crucial in order to monitor the emergence of transmitted viral resistance, and to produce evidence-based recommendations to support antiretroviral (ARV) policy in Mozambique.MethodsWorld Health Organization (WHO) methodology was used to evaluate transmitted drug resistance (TDR) in newly diagnosed HIV-1 infected pregnant women attending ante-natal clinics in Maputo and Beira to non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI). Subtypes were assigned using REGA HIV-1 subtyping tool and phylogenetic trees constructed using MEGA version 5.ResultsAlthough mutations associated with resistance to all three drug were detected in these surveys, transmitted resistance was analyzed and classified as <5% in Maputo in both surveys for all three drug classes. Transmitted resistance to NNRTI in Beira in 2009 was classified between 5–15%, an increase from 2007 when no NNRTI mutations were found. All sequences clustered with subtype C.ConclusionsOur results show that the epidemic is dominated by subtype C, where the first-line option based on two NRTI and one NNRTI is still effective for treatment of HIV infection, but intermediate levels of TDR found in Beira reinforce the need for constant evaluation with continuing treatment expansion in Mozambique.
Highlights
The sub-Saharan region of Africa is the most severely HIV affected region of the globe, housing more than two thirds (69%) of the people living with HIV in the world and 70% of the AIDS related deaths in 2011 [1]
The simplified LQAS (SLQAS) algorithm was used for analysis of transmitted drug resistance (TDR) in Maputo for the 2007 survey
Maputo had 21 specimens available for classification of TDR for nucleoside reverse transcriptase inhibitors (NRTI) and nucleoside reverse transcriptase inhibitors (NNRTI), and only 23 specimens were available for TDR classification for protease inhibitors (PI)
Summary
The sub-Saharan region of Africa is the most severely HIV affected region of the globe, housing more than two thirds (69%) of the people living with HIV in the world and 70% of the AIDS related deaths in 2011 [1]. Mozambique is one of nine countries in the region with an HIV prevalence above 10% and shares geographical boarders with Swaziland and South Africa, countries bearing the world’s highest adult HIV prevalence and the largest population of people living with HIV, respectively [1,2] [1,2]. A National Survey on Prevalence, Behavioral Risks, and Information about HIV and AIDS in Mozambique (INSIDA) in 2009 confirmed an adult HIV prevalence of around. Before 2003, only people that could afford treatment abroad had access to antiretroviral (ARV) treatment in Mozambique. Patients failing first-line therapy are identified based on clinical and immunological criteria. Four options for second-line therapy are available based on the combination of Tenofovir, Lopinavir/Ritonavir (LPV/r); Abacavir, Didanosine and Saquinavir/Ritonavir [6,7]
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