HIV‐1 reverse transcriptase drug‐resistance mutations in chronically infected individuals receiving or naïve to HAART in Cameroon

Abstract

The most common first-line, highly active anti-retroviral therapy (HAART) received by individuals infected with HIV-1 in Cameroon is the combination therapy Triomune, comprised of two nucleoside reverse transcriptase inhibitors (NRTI) and one non-NRTI (NNRTI). To examine the efficacy of these drugs in Cameroon, where diverse non-B HIV-1 subtypes and recombinant viruses predominate, the reverse transcriptase (RT) viral sequences in patient plasma were analyzed for the presence of mutations that confer drug resistance. Forty-nine HIV-1-positive individuals were randomly selected from those receiving care in HIV/AIDS outpatient clinics in the South-West and North-West Regions of Cameroon. Among the 28 patients receiving HAART, 39% (11/28) had resistance to NRTIs, and 46% (13/28) to NNRTIs after a median of 12 months from the start of therapy. Among those with drug-resistance mutations, there was a median of 14 months from the start of HAART, versus 9 months for those without; no difference was observed in the average viral load (10,997 copies/ml vs. 8,056 copies/ml). In contrast, drug-naïve individuals had a significantly higher average viral load (27,929 copies/ml) than those receiving HAART (9,527 copies/ml). Strikingly, among the 21 drug-naïve individuals, 24% harbored viruses with drug-resistance mutations, suggesting that HIV-1 drug-resistant variants are being transmitted in Cameroon. Given the high frequency of resistance mutations among those on first-line HAART, coupled with the high prevalence of HIV-1 variants with drug-resistance mutations among drug-naïve individuals, this study emphasizes the need for extensive monitoring of resistance mutations and the introduction of a second-line HAART strategy in Cameroon.

Rates of Emergence of HIV Drug Resistance in Resource-Limited Settings: A Systematic Review

“…Of the articles and abstracts searched, seven fulfilled the criteria for the analysis of acquired HIV drug resistance [26–33] and twenty-two for the analysis of transmitted HIV drug resistance [24, 25, 26, 28, 34–51] (Figure 1). Two papers provided data for both analyses [28, 30].…”

Characterization of drug resistance mutations in naïve and ART‐treated patients infected with HIV‐1 in Yaounde, Cameroon

“…Previous data concerning the prevalence of drug resistance among ART‐experienced Cameroonian patients have been contradictory. In 2009 and 2010 two studies reported a drug resistance prevalence of 39 and 46% to NRTI and NNRTI, respectively [Kouanfack et al, 2009; Burda et al, 2010].…”

Transmitted Raltegravir Resistance in An HIV-1 Crf_Ag-Infected Patient

“…Transmitted resistance mutations affecting NRTIs, NNRTIs, and to a lesser extent PIs have been reported in patients with CRF_AG [9–10], similar to patients with other HIV subtypes and recombinant forms. Although many of our patient’s pre-treatment protease mutations are highly prevalent in treatment-naïve CRF_AG patients, 2–3 are major protease mutations [11–12] prevalent in less than 0.5% of treatment-naïve CRF_AG patients [7] (Table 1).…”