Evolution of primary HIV drug resistance in a subtype C dominated epidemic in Mozambique
PLos ONE; 7 (9), 2012
Ano de publicação: 2012
Objective:
InMozambique, highly active antiretroviral treatment (HAART) was introduced in 2004 followed by decentralizationandexpansion, resulting inamorethan20-fold increase incoverageby2009. ImplementationofHIV drugresistancethresholdsurveys (HIVDR-TS) iscrucial inorder tomonitor theemergenceof transmittedviral resistance, andtoproduceevidence-basedrecommendationstosupportantiretroviral (ARV)policyinMozambique.Methods:
WorldHealthOrganization(WHO)methodologywasusedtoevaluatetransmitteddrugresistance(TDR) innewly diagnosedHIV-1 infectedpregnantwomenattendingante-natal clinics inMaputoandBeira tonon-nucleosidereverse transcriptaseinhibitors(NNRTI),nucleosidereversetranscriptaseinhibitors(NRTI)andproteaseinhibitors(PI).Subtypeswere assignedusingREGAHIV-1subtypingtoolandphylogenetictreesconstructedusingMEGAversion5.Results:
Althoughmutations associatedwith resistance toall threedrugweredetected in these surveys, transmitted resistancewasanalyzedandclassifiedas,5%inMaputoinbothsurveysforallthreedrugclasses.Transmittedresistanceto NNRTI inBeira in2009wasclassifiedbetween5–15%, anincreasefrom2007whennoNNRTImutationswerefound.All sequencesclusteredwithsubtypeC.Conclusions:
OurresultsshowthattheepidemicisdominatedbysubtypeC,wherethefirst-lineoptionbasedontwoNRTI andoneNNRTI isstilleffectivefor treatmentofHIVinfection,but intermediatelevelsofTDRfoundinBeirareinforcethe needforconstantevaluationwithcontinuingtreatmentexpansioninMozambique.
Fármacos Anti-HIV/farmacologia, Fármacos Anti-HIV/uso terapêutico, Terapia Antirretroviral de Alta Atividade, Moçambique, Farmacorresistência Viral/genética, Infecções por HIV/terapia, Infecções por HIV/epidemiologia, Infecções por HIV/virologia, HIV-1/classificação, HIV-1/efeitos da radiação, HIV-1/genética, Moçambique/epidemiologia, Mutação, Filogenia