14th International AIDS Conference Barcelona, Spain — July 7-12, 2002

Int Conf AIDS. 2002 Jul 7-12;14:Abstract No. TuPeB4607

[ABSTRACT:] Introduction: Current knowledge and research of HIV-1 antiretroviral (ARV) drug resistance is mainly limited to HIV-1 subtype B. The HIV-1 subtype C, prevalent in Southern Africa, contains unique genetic and biochemical properties that may foster the development of earlier and/or distinct pol gene drug resistance mutations. Since the government of Botswana plans to introduce antiretroviral drugs into the public health sector, we sought to evaluate the prevalence of drug resistance prior to initiating the public sector program.

METHODS: Blood specimens were initially collected from blood donors and later from representative national sites as part of the 2001 Sentinel Surveillance. Plasma RNA and proviral DNA were used for pol gene sequencing.

RESULTS: At present, data is available from Gaborone and nearby villages for 51 HIV-1 infected patients. Of these initial 51 specimens, primary or secondary resistance to NRTI and NNRTI classes of drugs was recognized in only 1 /52 (2.0%) of drug naïve patients. Primary resistance to the PI class was found in 2/51 (4%) ARV naïve patients [D30N for nelfinavir (NLF) and V82S and I84V for indinavir (IDV)]. However, secondary mutations for the PIs were found in 41/51 (80%) of patients [M36I for both IDV and NLF]. 8/51 (15%) of patients also exhibited the K20M/R secondary mutation for IDV, and 5/51 (10%) of patients had the V77I secondary mutation for both IDV and NFV. Additional specimens, including representative samples from the other regions of Botswana will be sequenced.

Conclusion: The baseline prevalence of primary drug resistance mutations to all 3 classes of ARV agents in Botswana is very low. Significant rates of secondary resistance mutations to the PI class exist, but the clinical significance of this remains to be elucidated. The Botswana Ministry of Health will proceed with its plan to offer PI sparing NRTI / NNRTI combinations as first-line treatment.

Presenting author: Vladimir Novitsky

1Botswana-Harvard Partnership, Dept. Immunology & Infectious Diseases, Harvard School of Public Helath, FXB-310, 651 Huntington Avenue, Boston, MA 02115, Botswana.

2Harvard AIDS Institute, Boston, United States.

3National AIDS Coordinating Agency, Gaborone, Botswana.

4AIDS-STD Unit, Gaborone, Botswana.

5National Blood Transfusion Center, Gaborone, Botswana.

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Copyright © 2002 - International AIDS Society (IAS). Reproduction of this abstract (other than one copy for personal reference) must be cleared through the IAS.