Clinical and Public Health Implications of HIV-1 Genetic Diversity and Drug Resistance Mutations in Angola: A Systematic Review
Cruz S. Sebastião 1, Joana de Morais 2, Miguel Brito 3
1 Global Health and Tropical Medicine, GHTM, Associate Laboratory in Translation and Innovation Towards Global Health, LA-REAL, Instituto de Higiene e Medicina Tropical, Universidade NOVA de Lisboa, Lisboa, Portugal; Centro Nacional de Investigação Científica (CNIC), Luanda, Angola; Instituto Nacional de Investigação em Saúde, Luanda, Angola; Centro de Investigação em Saúde de Angola, Caxito, Angola; 2 Faculdade de Medicina, Universidade Agostinho Neto, Luanda, Angola; Instituto Nacional de Investigação em Saúde, Luanda, Angola; 3 Centro de Investigação em Saúde de Angola, Luanda, Angola; Health and Technology Research Center, Escola Superior de Tecnologia da Saúde de Lisboa, Instituto Politécnico de Lisboa, Lisboa, Portugal
*Correspondence: Cruz S. Sebastião, Email not available
Abstract
HIV-1 genetic diversity and drug resistance mutations (DRMs) remain a public health concern mainly in low- and middle-income countries. In this review, we estimated the HIV-1 molecular evolution over the past 40 years (1980-2019) in Angola to help guide affordable strategies for HIV-1 epidemic surveillance. We searched for studies written in English or Portuguese on HIV-1 diversity and DRMs carried out in Angola and published between 1980 and 2019. This review yielded eight studies describing a total of 493 samples. No HIV-1 Group N, O, and P were identified, whereas a ll non-B subtypes f rom Group M were identified. About 66% of HIV-1 subtypes were pure subtype and 34% recombinant strains. The frequency of recombinant strains increases from 1980 to 2019 (23.6%-41.4%, p<0.001). The subtypes C, F1, CRF02_AG, and the recombinant U/H were the most frequent. One DRM in the PIs was found (I54 M), 22 in the nucleoside reverse transcriptase inhibitors (NRTIs), and 18 in the non-nucleoside reverse transcriptase inhibitors (NNRTIs). The major DRM in the NRTIs was the M184V, whereas the G190A, K103N, and Y181C were the major DRMs in the NNRTIs. Over the past 40 years, the frequency of the DRM M184V (50-64.3%, p=0.363), G190A (17.2-46.2%, p=0.021), and K103N (34.5-42.3%, p=0.551) increased, while the frequency of Y181C (17.2-7.7%, p=0.289) decreased. The current review shows an increase in HIV-1 genetic complexity and DRMs in Angola. Our findings suggest the need to include PIs or integrase strand transfer inhibitors in the first-line antiretroviral therapy regimens in Angola.
