Abstract
HIV-1 and HIV-2 have been detected in Cape Verde since 1987, but little is known regarding the genetic diversity of these viruses in this archipelago, located near the West African coast. In this study, we characterized the molecular epidemiology of HIV-1 and HIV-2 and described the occurrence of drug resistance mutations (DRM) among antiretroviral therapy naïve (ARTn) patients and patients under treatment (ARTexp) from different Cape Verde islands. Blood samples, socio-demographic and clinical-laboratory data were obtained from 221 HIV-positive individuals during 2010–2011. Phylogenetic and bootscan analyses of the pol region (1300 bp) were performed for viral subtyping. HIV-1 and HIV-2 DRM were evaluated for ARTn and ARTexp patients using the Stanford HIV Database and HIV-GRADE e.V. Algorithm Homepage, respectively. Among the 221 patients (169 [76.5%] HIV-1, 43 [19.5%] HIV-2 and 9 [4.1%] HIV-1/HIV-2 co-infections), 67% were female. The median ages were 34 (IQR = 1–75) and 47 (IQR = 12–84) for HIV-1 and HIV-2, respectively. HIV-1 infections were due to subtypes G (36.6%), CRF02_AG (30.6%), F1 (9.7%), URFs (10.4%), B (5.2%), CRF05_DF (3.0%), C (2.2%), CRF06_cpx (0.7%), CRF25_cpx (0.7%) and CRF49_cpx (0.7%), whereas all HIV-2 infections belonged to group A. Transmitted DRM (TDRM) was observed in 3.4% (2/58) of ARTn HIV-1-infected patients (1.7% NRTI, 1.7% NNRTI), but not among those with HIV-2. Among ARTexp patients, DRM was observed in 47.8% (33/69) of HIV-1 (37.7% NRTI, 37.7% NNRTI, 7.4% PI, 33.3% for two classes) and 17.6% (3/17) of HIV-2-infections (17.6% NRTI, 11.8% PI, 11.8% both). This study indicates that Cape Verde has a complex and unique HIV-1 molecular epidemiological scenario dominated by HIV-1 subtypes G, CRF02_AG and F1 and HIV-2 subtype A. The occurrence of TDRM and the relatively high level of DRM among treated patients are of concern. Continuous monitoring of patients on ART, including genotyping, are public policies to be implemented.
Highlights
Human Immunodeficiency Virus (HIV), the etiologic agent of Acquired Immunodeficiency Syndrome (AIDS), remains a challenge in the 21st century, even more than 30 years after its discovery
This study indicates that Cape Verde has a complex and unique HIV-1 molecular epidemiological scenario dominated by HIV-1 subtypes G, CRF02_AG and F1 and HIV-2 subtype A
Based on the polymerase sequences obtained from the HIV-1 and HIV-2 positive individuals from Cape Verde, we evaluated the occurrence of drug resistance mutations (DRM) to the antiretroviral drugs implemented in the country at the end of 2004
Summary
Human Immunodeficiency Virus (HIV), the etiologic agent of Acquired Immunodeficiency Syndrome (AIDS), remains a challenge in the 21st century, even more than 30 years after its discovery. At the end of 2012, 35.3 million people were living with HIV, and approximately 10.6 million people received antiretroviral treatment (ART) [7]. The increase of ART availability brings a challenge in monitoring the emergence of drug resistance mutations (DRM) on naıve and treated patients, in countries with limited capacities to implement genotyping tests. The fully described differences on the susceptibility of HIV-1 and HIV-2 to the currently available classes of antiretroviral drugs are challenges for patient management in countries where the two viruses co-circulate [10]
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