Abstract
Data on antiretroviral drug resistance among drug-naive persons are important in developing sentinel and surveillance policies. This study was conducted to determine the prevalence of antiretroviral drug resistance mutations among drug-naïve HIV-infected individuals attending a voluntary testing and counselling centre at the Mankweng Hospital in northeastern South Africa. In total, 79 drug-naïve HIV-positive individuals were sequentially recruited during February 2008-December 2008. Drug resistance mutations were determined using the calibrated population resistance tool available on the Stanford HIV drug resistance database. Viral DNA was obtained from 57 (72%) of the 79 individuals. Reliable nucleotide sequences were obtained for 54 reverse transcriptase (RT) and 54 protease (PR) gene regions from 54 individuals. Overall, five sequences (9.3%) harboured drug resistance mutations (95% confidence interval -1.53 to 16.99). Four (7.4%) of these were nucleoside RT inhibitor mutations (D67G, D67E, T69D, and T215Y), and one (1.9%) was a PR inhibitor mutation (M46I). No major non-nucleoside RT resistance mutation was detected. Several minor resistance mutations and polymorphisms common in subtype C viruses were observed in the PR and RT genes. Phlyogenetic analysis of the partial pol sequences showed that 52 (96%) of the 54 isolates were HIV-1 subtype C. One isolate (08MB08ZA) was HIV-1 subtype B while another (08MB26ZA) was related to HIV-1 subtype J. HIV-1 subtype recombination analysis with REGA assigned the pol sequence to HIV subtype J (11_cpx) with a bootstrap value of 75%. The prevalence of drug resistance mutations observed in the population studied was relatively higher than previously reported from other parts of South Africa. In addition, this is apparently the first report of an HIV-1 subtype J-like virus from northeastern South Africa.
Highlights
The health and quality of life of patients infected with HIV/AIDS have dramatically improved since the introduction of highly-active antiretroviral therapy (HAART) in 1996 [1,2]
HAART has been used with remarkable success, and treatment is accompanied with regular virologic monitoring, including measurements of viral load and testing of drug resistance to guide management of patients [5,6]
The development of drug resistance is an important attribute of HIV
Summary
The health and quality of life of patients infected with HIV/AIDS have dramatically improved since the introduction of highly-active antiretroviral therapy (HAART) in 1996 [1,2]. One of the major drawbacks of HAART is the development of drug resistance which usually accompanies the. HAART has been used with remarkable success, and treatment is accompanied with regular virologic monitoring, including measurements of viral load and testing of drug resistance to guide management of patients [5,6]. Before 2004, ARVs were available only through private health establishments in South Africa, and due to the scarcity and prohibitive high cost, the majority of patients could not afford treatment. Before 2010, the South African ARV drug regimen guideline recommended the use of stavudine, lamivudine, and efavirenz (with nevirapine replacing efavirenz for women of childbearing age). Stavudine is still recommended where side-effects are tolerated [8]
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