Molecular Characterisation of Human Immunodeficiency Virus Type 1 and Determination of Drug Resistance among Antiretroviral Treated Patients Attending Kayanza District Hospital in Burundi

Abstract

The use of antiretroviral drugs to prolong lives of people living with HIV and AIDS and in their use in prevention of mother-to-child transmission of HIV is now firmly established in Sub-Saharan Africa .However, virological failure in management of HIV-1 infection has been reported to be between 11 to 24 % after 12 months of treatment; Out of these, acquired or transmitted drug resistance mutations have been reported at 71% to 90%. HIV-1 subtypes and patterns of drug resistance in HIV infected patients on ART is little known in Burundi. This cross-sectional study was aimed to characterize HIV subtypes and to determine drug resistance mutations in HIV-1 infected patients on ART attending Kayanza district hospital, Burundi. Using purposive sampling technique, 200 participants were recruited. All patients were ARV experienced based on 2008 Burundi National guidelines, the age distribution was unimodal and it peaked at 45 years. The 86% were above 18years and female accounted for 55%. Stratification by religion, 73.5% were Christian-Catholics while 52% were married. On the level of education, 82.5% (n=165) reported completing primary school while farming as occupation was reported by 65% and 94% reporting to earn below BIF 200 .Out of 200 patients, 12.5% were on tuberculosis (TB) medications while 57% had been on antiretroviral therapy for between six to ten years. U4mL of venous blood was collected from each patient that consented to participate in the study. Plasma viral loads were quantified using the Abbott m2000rt system. RT-PCR was done after extraction of nucleic acids from plasma with >1000 copies/mL. Sequencing was done on all amplified samples. Drug resistance was determined using the Stanford University database. Phylogenetic analyses were done using the neighbor joining method. From the two hundred patients; 13% (26/200) had virological failure. This was associated with multiple partners (P =0.016) and inconsistency in taking medications (p=0.014). Fifteen samples were successfully sequenced; of these, (12/15) 80% were HIV-1 subtype C, 13% (2/15) were HIV-1 subtype A1 and 7% (1/15) were subtype A. Of the successfully sequenced, 80% (12/15) recorded at least one mutation (NRTI or NNRTI), while 20% (3/15) did not carry any Drug Resistance Mutations. The most common drug resistance mutations were M184V(7/15), M41L(1/15), E44D(1/15), L74I(1/15), L210W(1/15) and K65R(1/15), K103N(12/15),E138A (/15) and Y188H (1/15). These findings showed potential gaps in the last 90% of the 90-90-90 WHO target by 2020. More strategies are needed so as to improve adherence, while drug resistance mutation testing should be implemented to monitor HIV-1 patients on ART in Burundi