TY - JOUR
T1 - Evolution of Primary HIV Drug Resistance in a Subtype C Dominated Epidemic in Mozambique
AU - Bila, Dulce Celina Adolfo
AU - Young, Peter
AU - Merks, Harriet
AU - Vubil, Adolfo Salvador
AU - Mahomed, Mussagy
AU - Augusto, Angelo
AU - Abreu, Celina Monteiro
AU - Mabunda, Nédio Jonas
AU - Brooks, James I.
AU - Tanuri, Amilcar
AU - Jani, Ilesh Vinodrai
N1 - Funding Information:
Dulce Bila is a PhD student at the Laboratório de Virologia Molecular, Universidade Federal do Rio de Janeiro, Brazil and receives a fellowship from CAPES/Ministry of Education, Brazil. We are grateful to the National HIV and Retrovirology Laboratory at the Public Health Agency of Canada for providing training and reagents for HIV genotyping. The authors would like acknowledge the study participants and work done by the health care providers in the ANC clinics and laboratory technicians at reference laboratory in Mozambique.
PY - 2013/7/30
Y1 - 2013/7/30
N2 - Objective:In Mozambique, highly active antiretroviral treatment (HAART) was introduced in 2004 followed by decentralization and expansion, resulting in a more than 20-fold increase in coverage by 2009. Implementation of HIV drug resistance threshold surveys (HIVDR-TS) is crucial in order to monitor the emergence of transmitted viral resistance, and to produce evidence-based recommendations to support antiretroviral (ARV) policy in Mozambique.Methods:World Health Organization (WHO) methodology was used to evaluate transmitted drug resistance (TDR) in newly diagnosed HIV-1 infected pregnant women attending ante-natal clinics in Maputo and Beira to non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI). Subtypes were assigned using REGA HIV-1 subtyping tool and phylogenetic trees constructed using MEGA version 5.Results:Although mutations associated with resistance to all three drug were detected in these surveys, transmitted resistance was analyzed and classified as <5% in Maputo in both surveys for all three drug classes. Transmitted resistance to NNRTI in Beira in 2009 was classified between 5-15%, an increase from 2007 when no NNRTI mutations were found. All sequences clustered with subtype C.Conclusions:Our results show that the epidemic is dominated by subtype C, where the first-line option based on two NRTI and one NNRTI is still effective for treatment of HIV infection, but intermediate levels of TDR found in Beira reinforce the need for constant evaluation with continuing treatment expansion in Mozambique.
AB - Objective:In Mozambique, highly active antiretroviral treatment (HAART) was introduced in 2004 followed by decentralization and expansion, resulting in a more than 20-fold increase in coverage by 2009. Implementation of HIV drug resistance threshold surveys (HIVDR-TS) is crucial in order to monitor the emergence of transmitted viral resistance, and to produce evidence-based recommendations to support antiretroviral (ARV) policy in Mozambique.Methods:World Health Organization (WHO) methodology was used to evaluate transmitted drug resistance (TDR) in newly diagnosed HIV-1 infected pregnant women attending ante-natal clinics in Maputo and Beira to non-nucleoside reverse transcriptase inhibitors (NNRTI), nucleoside reverse transcriptase inhibitors (NRTI) and protease inhibitors (PI). Subtypes were assigned using REGA HIV-1 subtyping tool and phylogenetic trees constructed using MEGA version 5.Results:Although mutations associated with resistance to all three drug were detected in these surveys, transmitted resistance was analyzed and classified as <5% in Maputo in both surveys for all three drug classes. Transmitted resistance to NNRTI in Beira in 2009 was classified between 5-15%, an increase from 2007 when no NNRTI mutations were found. All sequences clustered with subtype C.Conclusions:Our results show that the epidemic is dominated by subtype C, where the first-line option based on two NRTI and one NNRTI is still effective for treatment of HIV infection, but intermediate levels of TDR found in Beira reinforce the need for constant evaluation with continuing treatment expansion in Mozambique.
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U2 - 10.1371/journal.pone.0068213
DO - 10.1371/journal.pone.0068213
M3 - Article
C2 - 23935858
AN - SCOPUS:84880772571
VL - 8
JO - PLoS One
JF - PLoS One
SN - 1932-6203
IS - 7
M1 - e68213
ER -