Abstract
BackgroundThe development of pretreatment drug resistance (PDR) is becoming an obstacle to the success of antiretroviral therapy (ART). Besides, data from developing settings including Ethiopia is still limited. Therefore, this study was aimed to assess HIV-1 genetic diversity and PDR mutations among ART-naive recently diagnosed HIV-1 infected individuals in Addis Ababa, Ethiopia.MethodsInstitutional based cross-sectional study was conducted from June to December 2018 in Addis Ababa among ART-naive recently diagnosed individuals. Partial HIV-1 pol region covering the entire protease (PR) and partial reverse transcriptase (RT) regions of 51 samples were amplified and sequenced using an in-house assay. Drug resistance mutations were examined using calibrated population resistance (CPR) tool version 6.0 from the Stanford HIV drug resistance database and the International Antiviral Society-USA (IAS-USA) 2019 mutation list.ResultsAccording to both algorithms used, 9.8% (5/51) of analyzed samples had at least one PDR Mutation. PDR mutations to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs) were the most frequently detected (7.8% and 9.8%, according to the CPR tool and IAS-USA algorithm, respectively). The most frequently observed NNRTIs-associated mutations common to both algorithms were K103N (2%), Y188L (2%), K101E (2%), and V106A (2%), while E138A (2%) was observed according to IAS-USA only. Y115F and M184V (mutations that confer resistance to NRTIs) dual mutations were detected according to both criteria in a single study participant (2%). PDR mutation to protease inhibitors was found to be low (only G73S; 2% according to the CPR tool). Phylogenetic analysis showed that 98% (50/51) of the study participants were infected with HIV-1C virus while one individual (2%) was infected with HIV-1A1 virus.ConclusionsThis study showed an increased level of PDR and persistence HIV-1C clade homogeneity after 15 years of the rollout of ART and 3 decades of HIV-1C circulation in Ethiopia, respectively. Therefore, we recommend routine baseline genotypic drug resistance testing for all newly diagnosed HIV infected patients before initiating treatment. This will aid the selection of appropriate therapy in achieving the 90% of patients having an undetectable viral load in consonance with the UN target.
Highlights
The development of pretreatment drug resistance (PDR) is becoming an obstacle to the success of antiretroviral therapy (ART)
Human Immunodeficiency Virus (HIV)‐1 genetic diversity With regard to HIV-1 genetic diversity, phylogenetic analysis using the REGA HIV-1 subtyping tool. showed that 98% (50/51) of the study participants were infected with HIV-1C virus while one individual (2%: 1/51) was infected with the HIV-1A1 virus
The finding of this study indicates that 98% (50/51) of the study participants were infected with HIV-1C virus while one individual (2%) was infected with HIV-1 A1 virus
Summary
The development of pretreatment drug resistance (PDR) is becoming an obstacle to the success of antiretroviral therapy (ART). This study was aimed to assess HIV-1 genetic diversity and PDR mutations among ART-naive recently diagnosed HIV-1 infected individuals in Addis Ababa, Ethiopia. In Eastern and Southern Africa, which is the home of 54% of the world’s people living with HIV [3], there were an estimated 800,000 new HIV infections which account for around 47% of the total global new infection and 310,000 people dying from Acquired Immuno Deficiency Syndrome (AIDS)related illness in the same year [3]. In Ethiopia, HIV/AIDS is among the top ten leading causes of age-standardized premature mortality and death [4]. In 2018, there were an estimated 23,000 new infections and 11,000 AIDS-related deaths [3]. There were an estimated 690,000 people living with HIV in the country in 2018 [3]. According to data from the Federal HIV/AIDS Prevention and Control Office, the HIV prevalence in the country in 2018 was 0.9% [6]
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