Prevalence of HIV-1 pretreatment drug resistance among treatment naïve pregnant women in Bissau, Guinea Bissau

Hans Norrgren,Jason Blackard,Sten Wilhelmson,Patrik Medstrand,Joakim Esbjörnsson,Fredrik Månsson,Ansu Biai,Jacob Lopatko Lindman,Marianne Jansson

doi:10.1371/journal.pone.0206406

Abstract

BackgroundWith increased access to antiretroviral treatment (ART) in sub-Saharan Africa emergence of HIV-1 pretreatment drug resistance constitutes a serious risk. This may lead to rapid virological failure in subjects initiating ART, and mother-to-child transmission despite prophylaxis.MethodsTreatment-naïve pregnant women from four antenatal care clinics in Bissau, Guinea-Bissau, were enrolled from October 2016 to November 2017. Genotypic resistance testing and phylogenetic subtype analysis was performed on 48 specimens.ResultsForty eight women met the survey inclusion criteria. All specimens were successfully amplified and genotyped. Specimens from five women were associated with HIV-1 drug resistance mutations. Four carried mutations exclusively linked to non-nucleoside reverse transcriptase inhibitors (NNRTIs) (K103N, K103N/S) and one carried mutations to both NNRTIs (G190S, K101E) and nucleoside reverse transcriptase inhibitors (NRTIs) (M184V). These results corresponded to 10.4% (95% CI: 4.5–22.2%), 2.1% (95% CI: 0.4–10.9%) and 0% (95% CI: 0.0–7.4%) drug resistance mutations to NNRTIs, NRTIs and protease inhibitors, respectively. HIV-1 circulating recombinant form 02AG was most commonly found, followed by HIV-1 sub-subtype A3. Subtype/CRF was not associated with drug resistance mutations.ConclusionOur study reports a 10.4% prevalence of pretreatment drug resistance to NNRTIs in HIV-1-infected pregnant women in the capital Bissau, Guinea Bissau. Since NNRTIs are part of first-line ART in the country, baseline resistance screenings or adjustment of national treatment guidelines should be considered as antiretroviral treatment programs are scaled up.

Highlights

Guinea-Bissau is a small multi-ethnic West African country with 1.8 million inhabitants, of whom 300,000 reside in the capital, Bissau [1]
Specimens from five women were associated with human immunodeficiency virus type 1 (HIV-1) drug resistance mutations
Four carried mutations exclusively linked to non-nucleoside reverse transcriptase inhibitors (NNRTIs) (K103N, K103N/S) and one carried mutations to both nucleotide reverse transcriptase inhibitor (NNRTI) (G190S, K101E) and nucleoside reverse transcriptase inhibitors (NRTIs) (M184V). These results corresponded to 10.4%, 2.1% and 0% drug resistance mutations to NNRTIs, NRTIs and protease inhibitors, respectively

Summary

Introduction

Guinea-Bissau is a small multi-ethnic West African country with 1.8 million inhabitants, of whom 300,000 reside in the capital, Bissau [1]. The human immunodeficiency virus type 1 (HIV-1) prevalence among adults, 15– 49 years, is estimated to 3.1%, but is higher among women than men (3.8% vs 2.4%) [2]. The national antiretroviral treatment (ART) program in Guinea-Bissau was initiated in 2005. As in most low and middle income countries (LMIC), ART follows the WHO guidelines with use of two nucleoside reverse transcriptase inhibitors (NRTIs) and one non-nucleotide reverse transcriptase inhibitor (NNRTI) [3]. About 35% of eligible HIV positive adults and 15% of the children received ART in 2016, while the proportion of pregnant women who received prevention from mother to child transmission (PMTCT) prophylaxis was 85% [2]. High numbers of loss to follow-up, mortality and development of HIV drug resistance (DR) during treatment (acquired DR) have been reported in the country [4]

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