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MCCLUSKEY SM, KAMELIAN K, MUSINGUZI N, KIGOZI S, BOUM Y, BWANA MB, MUZOORA C, BRUMME ZL, CARRINGTON M, CARLSON J, FOLEY B, HUNT PW, MARTIN JN, BANGSBERG DR, HARRIGAN PR, SIEDNER MJ, HABERER JE, LEE GQ. Pre-treatment integrase inhibitor resistance is uncommon in antiretroviral therapy-naive individuals with HIV-1 subtype A1 and D infections in Uganda. AIDS 2021; 35:1083-1089. [PMID: 33635845 PMCID: PMC8102316 DOI: 10.1097/qad.0000000000002854] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE Dolutegravir (DTG) is now a preferred component of first-line antiretroviral therapy (ART). However, prevalence data on natural resistance to integrase inhibitors [integrase strand transfer inhibitors (INSTIs)] in circulating non-subtype B HIV-1 in sub-Saharan Africa is scarce. Our objective is to report prevalence of pre-treatment integrase polymorphisms associated with resistance to INSTIs in an ART-naive cohort with diverse HIV-1 subtypes. DESIGN We retrospectively examined HIV-1 integrase sequences from Uganda. METHODS Plasma samples were derived from the Uganda AIDS Rural Treatment Outcomes (UARTO) cohort, reflecting enrollment from 2002 to 2010, prior to initiation of ART. HIV-1 integrase was amplified using nested-PCR and Sanger-sequenced (HXB2 4230-5093). Stanford HIVdb v8.8 was used to infer clinically significant INSTI-associated mutations. Human leukocyte antigen (HLA) typing was performed for all study participants. RESULTS Plasma samples from 511 ART-naive individuals (subtype: 48% A1, 39% D) yielded HIV-1 integrase genotyping results. Six out of 511 participants (1.2%) had any major INSTI-associated mutations. Of these, two had E138T (subtype A1), three had E138E/K (subtype D), and one had T66T/I (subtype D). No participants had mutations traditionally associated with high levels of INSTI resistance. HLA genotypes A∗02:01/05/14, B∗44:15, and C∗04:07 predicted the presence of L74I, a mutation recently observed in association with long-acting INSTI cabotegravir virologic failure. CONCLUSION We detected no HIV-1 polymorphisms associated with high levels of DTG resistance in Uganda in the pre-DTG era. Our results support widespread implementation of DTG but careful monitoring of patients on INSTI with virologic failure is warranted to determine if unique mutations predict failure for non-B subtypes of HIV-1.
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Affiliation(s)
- Suzanne M. MCCLUSKEY
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Kimia KAMELIAN
- Division of AIDS, University of British Columbia, Vancouver, BC, Canada
| | | | - Simone KIGOZI
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Yap BOUM
- Mbarara University of Science and Technology, Mbarara, Uganda
| | | | - Conrad MUZOORA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Zabrina L. BRUMME
- Simon Fraser University, Burnaby, BC, Canada
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
| | - Mary CARRINGTON
- Basic Science Program, Frederick National Laboratory for Cancer Research in the Laboratory of Integrative Cancer Immunology, National Cancer Institute, Bethesda, MD, USA
- Ragon Institute of MGH, MIT, and Harvard, Boston, MA, USA
| | | | - Brian FOLEY
- Los Alamos National Laboratory, Los Alamos, NM, USA
| | | | | | | | | | - Mark J. SIEDNER
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- Mbarara University of Science and Technology, Mbarara, Uganda
| | - Jessica E. HABERER
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
| | - Guinevere Q. LEE
- Massachusetts General Hospital, Boston, USA
- Harvard Medical School, Boston, MA, USA
- BC Centre for Excellence in HIV/AIDS, Vancouver, BC, Canada
- Weill Cornell Medicine, New York, NY, USA
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