학술논문
Pre-Treatment HIV Drug Resistance and Genetic Diversity in Cameroon: Implications for First-Line Regimens.
Document Type
Article
Author
Fokam, Joseph; Chenwi, Collins Ambe; Tala, Valère; Takou, Désiré; Santoro, Maria Mercedes; Teto, George; Dambaya, Beatrice; Anubodem, Felix; Semengue, Ezechiel Ngoufack Jagni; Beloumou, Grace; Djupsa, Sandrine; Assomo, Edgar; Fokunang, Charles; Alteri, Claudia; Billong, Serge; Bouba, Nounouce Pamen; Ajeh, Rogers; Colizzi, Vittorio; Mbanya, Dora; Ceccherini-Silberstein, Francesca
Source
Subject
*ANTI-HIV agents
*DRUG resistance
*GENETIC variation
*ANTIRETROVIRAL agents
*HIV
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Language
ISSN
1999-4915
Abstract
The efficacy of first-line antiretroviral therapy (ART) may be hampered by the presence of HIV drug resistance (HIVDR). We described HIV-1 pre-treatment drug resistance (PDR) patterns, effect of viral clades on PDR, and programmatic implications on first-line regimens in Cameroon. A sentinel surveillance of PDR was conducted from 2014 to 2019. Sequencing of HIV-1 protease and reverse transcriptase was performed, and HIVDR was interpreted using Stanford HIVdb.v.9.4. In total, 379 sequences were obtained from participants (62% female, mean age 36 ± 10 years). The overall PDR rate was 15.0% [95% CI: 11.8–19.0] nationwide, with significant disparity between regions (p = 0.03). NNRTI PDR was highest (12.4%), of which 7.9% had DRMs to EFV/NVP. Two regions had EFV/NVP PDR above the 10% critical threshold, namely the Far North (15%) and East (10.9%). Eighteen viral strains were identified, predominated by CRF02_AG (65.4%), with no influence of genetic diversity PDR occurrence. TDF-3TC-DTG predictive efficacy was superior (98.4%) to TDF-3TC-EFV (92%), p < 0.0001. The overall high rate of PDR in Cameroon, not substantially affected by the wide HIV-1 genetic diversity, underscores the poor efficacy of EFV/NVP-based first-line ART nationwide, with major implications in two regions of the country. This supports the need for a rapid transition to NNRTI-sparing regimens, with TDF-3TC-DTG having optimal efficacy at the programmatic level. [ABSTRACT FROM AUTHOR]