Abstract
ObjectivesThis is the first study describing drug resistance mutations (DRM) and HIV-1 variants among infected pregnant women in Equatorial Guinea (GQ), a country with high (6.2%) and increasing HIV prevalence.MethodsDried blood spots (DBS) were collected from November 2012 to December 2013 from 69 HIV-1 infected women participating in a prevention of mother-to-child transmission program in the Hospital Regional of Bata and Primary Health Care Centre María Rafols, Bata, GQ. The transmitted (TDR) or acquired (ADR) antiretroviral drug resistance mutations at partial pol sequence among naive or antiretroviral therapy (ART)-exposed women were defined following WHO or IAS USA 2015 lists, respectively. HIV-1 variants were identified by phylogenetic analyses.ResultsA total of 38 of 69 HIV-1 specimens were successfully amplified and sequenced. Thirty (79%) belonged to ART-experienced women: 15 exposed to nucleoside reverse transcriptase inhibitors (NRTI) monotherapy, and 15 to combined ART (cART) as first regimen including two NRTI and one non-NRTI (NNRTI) or one protease inhibitor (PI). The TDR rate was only found for PI (3.4%). The ADR rate was 37.5% for NNRTI, 8.7% for NRTI and absent for PI or NRTI+NNRTI. HIV-1 group M non-B variants caused most (97.4%) infections, mainly (78.9%) recombinants: CRF02_AG (55.2%), CRF22_A101 (10.5%), subtype C (10.5%), unique recombinants (5.3%), and A3, D, F2, G, CRF06_cpx and CRF11_cpx (2.6% each).ConclusionsThe high rate of ADR to retrotranscriptase inhibitors (mainly to NNRTIs) observed among pretreated pregnant women reinforces the importance of systematic DRM monitoring in GQ to reduce HIV-1 resistance transmission and to optimize first and second-line ART regimens when DRM are present.
Highlights
Equatorial Guinea (GQ) is a small country located in West Central Africa between Cameroon and Gabon
The transmitted antiretroviral drug resistance mutations (TDR) rate was only found for protease inhibitor (PI) (3.4%)
The high rate of antiretroviral drug resistance mutations (ADR) to retrotranscriptase inhibitors observed among pretreated pregnant women reinforces the importance of systematic drug resistance mutations (DRM) monitoring in GQ to reduce HIV-1 resistance transmission and to optimize first and second-line antiretroviral therapy (ART) regimens when DRM are present
Summary
Equatorial Guinea (GQ) is a small country located in West Central Africa between Cameroon and Gabon. The use of antiretroviral therapy (ART) started on a regular basis in 2005 in GQ, sporadic treatments, interrupted exposure to drugs, and high rates of loss to follow-up could have caused the appearance of resistance mutations, affecting the success of a future systematic antiretroviral program if the drug families causing resistance were still given to women carrying resistant viruses. The use of antiretroviral (ARV) regimens with a high genetic barrier to resistance, including new drug families, combined with improved patient adherence may mitigate acquired antiretroviral drug resistance mutations (ADR) rates, reducing the generation of new ARV-resistant strains. Their higher prices are problematic for their wide use in poor countries with high HIV prevalence
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