Access to genotyping assays to determine successful antiretroviral treatment (ART) is limited in resource-constrained settings by high cost, suggesting the need for a cost-effective and simplified method to identify HIV-1 drug resistance (HIVDR) mutations. In this study, an amplification refractory mutation system (ARMS)-PCR assay was developed and used to investigate the most frequent HIVDR mutations affecting first-line ART in settings where WHO ART guidelines are applied. Seventy-five HIV-positive (HIV ؉ ) samples from Cameroon were used to assess the performance of this assay. Sequencing of HIV-1 reverse transcriptase was simultaneously performed for comparison, and discordant samples were tested with a Trugene HIV-1 genotyping kit. The ARMS-PCR assay was able to detect M184V, T215Y/F, K103N, and Y181C mutations with sensitivities of 96.8%, 85.7%, 91.3%, and 70%, respectively, and specificities of 90.6%, 95%, 100%, 96.9%, respectively, compared with data on sequencing. The results indicated the highest positive predictive value for K103N (100%) and the highest negative predictive value for M184V (97.5%). ARMS-PCR's limits of detection for mutations M184V, T215Y/F, K103N, and Y181C were <75 copies/ml, 143 copies/ ml, 143 copies/ml, and 836 copies/ml, respectively. ARMS-PCR efficiently identified mutations in individuals harboring different HIV-1 clades (CRF02_AG and non-CRF02_AG). In addition, this approach was more cost-effective than other genotyping assays. The high throughput, the cost-effectiveness, and the simplicity of the ARMS-PCR assay make it a suitable tool to monitor HIVDR patterns in resource-constrained settings with broad HIV-1 genetic diversity.
In recent years, significant progress has been made in the treatment of HIV-infected patients. Gains in antiretroviral treatment have been achieved in low-and middle-income countries with more than 9.7 million people living with HIV/AIDS, 7.2 million of whom lived in sub-Saharan Africa as of the end of 2012 (35). This scaling up of antiretroviral therapy in resource-constrained settings, where the logistics of medication disbursement and patient follow-up are not always optimal, results in the emergence and transmission of HIV drug-resistant variants, thus providing obstacles to successful antiretroviral treatment (ART) programs (1). The monitoring of HIV drug-resistant mutations in developed countries is an important aspect of clinical management of HIV infection. In these developed countries, sequencing-based drug resistance assays are used to select the most appropriate regimens when initiating or switching ART (2, 3). In resource-constrained settings, due to high cost, only a limited number of HIV drug resistance mutation tests are performed for patient management. In such countries, the majority of tests are used for research purposes or for surveillance of HIV-1 drug resistance (HIVDR) mutations recommended by WHO to update antiretroviral therapy policies (4, 5).Resource-constrained settings use the WHO public health approach for the treatment of...