HIV-1 DRUG RESISTANCE PROFILES IN SUBTYPES A AND D AMONG PRETREATMENT HIV PATIENTS IN UGANDA.

Abstract

Background The ability of HIV to mutate and reproduce itself in the presence of antiretroviral drugs is called HIV drug resistance. HIV drug resistance can result in treatment failure and further spread of drug resistant HIV. Transmission of drug resistant virus can compromise the effectiveness of the limited therapeutic options available to treat HIV thus increase HIV incidence, mortality and morbidity. In addition, there is scale up of HIV patients on treatments that is test and treat and there is need to look at the trends of HIV pretreatment resistance over a period of time as this is key in preventing, monitoring and responding to emergency of HIV-1 drug resistance. Objectives This study compared the drug resistance profiles in HIV-1 subtype A and D harbored by pretreatment HIV patients in Uganda as well as showing the trends in pretreatment drug resistance profiles in subtypes A and D over a retrospective period of years. The data generated in this study informs policy and clinicians so as to design better treatment strategy for patients prior to initiation of treatment. Methodology This was a cross sectional study for objective one and retrospective study for objective two. The study was done at done at Joint Clinical Research Centre in the CFAR Lab and retrieved plasma sample for pretreatment HIV patients were used for specific objective one and for the other specific objective two, HIV-1 nucleic acid sequences were downloaded from the HIV Stanford data base and analyzed. Laboratory procedures included extraction of viral RNA, PCR and Sanger sequencing. Analysis and interpretation of resistance profiles was done by Recall and Stanford HIV-1 data base respectively. Subtyping was done by REGA HIV-1 subtyping tool. Results Subtype A was the most frequent with 46% followed by subtype D 38% the rest of the subtypes (A2, B, C, A&D, C&D and G) were 1.9 %. The difference in resistance between Subtype A and subtype D was not statistically significant. Trends in pretreatment drug resistance were high in NNRTI’s than NRTIs PIS and INTIS. The trends in pretreatment drug resistance in both the xi

NRTI’S and NNRTI’s were both high in 2019. This study showed a high prevalence of transmitted drug resistance mutations in Reverse Transcriptase region in the study population. The trend in transmitted drug resistance was high in Subtype A as compared to subtype D. Conclusion The findings in this study showed a moderate prevalence of transmitted drug resistance mutations in the study populations with 2019 having a high percentage of resistance. Thus these findings calls support for improved focused quality of HIV services