Abstract
BackgroundAngola presents a very complex HIV-1 epidemic characterized by the co-circulation of several HIV-1 group M subtypes, intersubtype recombinants and unclassified (U) variants. The viral diversity outside the major metropolitan regions (Luanda and Cabinda) and the prevalence of transmitted drug resistance mutations (DRM) since the introduction of HAART in 2004, however, has been barely studied.MethodsOne hundred and one individuals from the Central (n = 44), North (n = 35), and South (n = 22) regions of Angola were diagnosed as HIV-1 positive and had their blood collected between 2008 and 2010, at one of the National Referral Centers for HIV diagnosis, the Kifangondo Medical Center, located in the border between the Luanda and Bengo provinces. Angolan samples were genotyped based on phylogenetic and bootscanning analyses of the pol (PR/RT) gene and their drug resistance profile was analyzed.ResultsAmong the 101 samples analyzed, 51% clustered within a pure group M subtype, 42% were classified as intersubtype recombinants, and 7% were denoted as U. We observed an important variation in the prevalence of different HIV-1 genetic variants among country regions, with high frequency of subtype F1 in the North (20%), intersubtype recombinants in the Central (42%), and subtype C in the South (45%). Statistically significant difference in HIV-1 clade distribution was only observed in subtype C prevalence between North vs South (p = 0.0005) and Central vs South (p = 0.0012) regions. DRM to NRTI and/or NNRTI were detected in 16.3% of patients analyzed.ConclusionsThese results demonstrate a heterogeneous distribution of HIV-1 genetic variants across different regions in Angola and also revealed an unexpected high frequency of DRM to RT inhibitors in patients that have reported no antiretroviral usage, which may decrease the efficiency of the standard first-line antiretroviral regimens currently used in the country.
Highlights
HIV remains a global health problem for the SubSaharan Africa region, where more than 22 million people live with HIV/Aids, 1.3 million adults and children are dying annually due to Aids-related diseases and is still the region most heavily affected by HIV and of major concern, especially for its contribution to the fastest moving Aids epidemic worldwide [1]
The molecular epidemiology profile of the HIV-1 epidemic in Angola is characterized by the circulation of most HIV-1 group M subtypes, a high proportion of Unique Recombinant Forms (URFs), some Circulating Recombinant Forms (CRFs), and other genetic forms that cannot be classified into the known subtypes [4,5,6,7,8]
None of the patients were under the regular antiretroviral therapy regimen, nine patients (9%) reported being part of a spiritual group where the head prescribed some natural herbs and drugs for treatment and six female patients (6%) later revealed that they were submitted to ARV (AZT+3TC+NEV or AZT+3TC+LVP/r) for preventing MTCT during delivery
Summary
HIV remains a global health problem for the SubSaharan Africa region, where more than 22 million people live with HIV/Aids, 1.3 million adults and children are dying annually due to Aids-related diseases and is still the region most heavily affected by HIV and of major concern, especially for its contribution to the fastest moving Aids epidemic worldwide [1].Angola, a Southwestern African country, borders Congo, the Democratic Republic of Congo (DRC), Zambia and Namibia, and is estimated to have a total population of ,18.5 million people according to recent international reports [2]. According to the UNAIDS 2010 epidemiological fact sheets, the estimated HIV prevalence within the adult population in Angola was 2% and about 11,000 annual deaths were AIDS-related in that year [1] This prevalence is comparable to that reported in Congo (3.2%), but much lower than those described in some African countries from the south region such as Zambia (14%), South Africa (17%), Namibia (21%) and Botswana (25%) [1]. The molecular epidemiology profile of the HIV-1 epidemic in Angola is characterized by the circulation of most HIV-1 group M subtypes, a high proportion of Unique Recombinant Forms (URFs), some Circulating Recombinant Forms (CRFs), and other genetic forms that cannot be classified into the known subtypes [4,5,6,7,8] This complex molecular pattern is similar to that described in some neighboring countries that border Angola in the North, like the DRC and Congo [9,10]. The viral diversity outside the major metropolitan regions (Luanda and Cabinda) and the prevalence of transmitted drug resistance mutations (DRM) since the introduction of HAART in 2004, has been barely studied
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