Undiagnosed Chronic Hepatitis B Infection and HIV Type 1 Drug Resistance Profile in AIDS Patients Receiving Tenofovir-containing Antiretroviral Regimens: Considerations for Monitoring Resistant HIV Variants during Treatment
Charles Kouanfack
Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Cameroon. & Yaounde Central Hospital, Cameroon.
Mathurin Kowo
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon. & University Hospital Centre, Yaounde, Cameroon.
Emmanuel Sako Haddison
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon.
Veronica Matehbi Aletum
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon. & Molecular Biology Laboratory, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon.
Desire Takou
Molecular Biology Laboratory, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon.
Patrick Awoumou
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon. & Molecular Biology Laboratory, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon.
Serge Christian Tchokonte
Yaounde Central Hospital, Cameroon.
Samuel Sosso
Clinical Diagnostic Laboratory, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon.
Njoya Oudou
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon. & University Hospital Centre, Yaounde, Cameroon.
Judith Ndongo Torimiro *
Faculty of Medicine and Biomedical Sciences, University of Yaounde I, Cameroon. & Molecular Biology Laboratory, Chantal Biya International Reference Centre for Research on HIV/AIDS Prevention and Management (CIRCB), Yaounde, Cameroon.
*Author to whom correspondence should be addressed.
Abstract
Background: During antiretroviral therapy (ART), resistant HIV-1 variants may be selected resulting in clinical failure. Co-infection rate of Hepatitis B virus in AIDS patients in Cameroon is 11.8%, but few studies have described the profile of resistance associated mutations (RAMs) in HIV in these patients on first-line ART containing antiviral drugs against hepatitis B infection. Thus, we aimed to determine the rate of HBV infection and profile of HIV-1 RAMs in AIDS patients on ART.
Methods: A cross-sectional study was carried out from November 2013 to April 2014 in two AIDS Treatment Centres in Yaoundé, Cameroon. Ninety-six adult AIDS patients on tenofovir-containing regimens were tested for HBsAg by serology. Direct sequencing of amplicons generated for the HIV-1 protease/reverse transcriptase region, was performed for 21 HIV/HBV co-infected patients. The Stanford HIV Drug Resistance Database tool was used to predict RAMs, and genotyping was determined by phylogeny.
Results: Overall, 21 patients were co-infected with HBV (21.9%). Eighteen (85.7%) of these were infected with recombinant variants, and HIV-1 CRF02_AG was most frequently identified (52.9%), and 15 (71.4%) harboured at least one RAM. Prediction of resistance to NNRTIs was reported in 14 (66.7%), and among 13 (61.9%) to NRTIs, 2 (9.5%) to PIs, and 8 (38.1%) carried Thymidine Analog Mutations (TAMs) of M184VI (61.9%), V75I (23.8%), T215F (23.8%), M41L (19.0%) and K70R (19.0%).
Conclusion: Rate of HBV infection and frequency of HIV-1 RAMs among AIDS patients on ART is high. The observed NNRTI RAMs may affect the susceptibility of efavirenz. Thus, the need to monitor HIV-1 drug resistance profile during treatment with unsuppressed viral load.
Keywords: HIV, HBV, drug resistance, mutations, variant, co-infection