HIV-1 genotyping and drug resistance mutations in Morocco (2009-2024): a systematic review addressing critical gaps in molecular surveillance
Maryam Ahmina 1, 2, Nada Lamrak 1, 2, Hicham El Annaz 1, 2, 3, Mohamed Rida-Tagagidid 1, 2, 3, Rachid Abi 4, 5, 3, Mohamed Elqatni 1, 2, 3, Abdelilah Laraqi 1, 3, Safae Elkochri 3, Elarbi Bouaiti 2, 3, Ahmed Reggad 1, 3, Youssef Addi 3, Bouchra El Mchichi 1, 3, Nadia Touil 1, 3, Khalid Ennibi 1, 2, 3, Idriss Amine Lahlou 1, 2, 3
1 Molecular Virology and Oncobiology Research Team, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco; 2 Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco; 3 Center of Virology, Infectious and Tropical Diseases, Mohamed V Military Instruction Hospital, Rabat, Morocco; 4 Molecular Virology and Oncobiology Research Team, Faculty of Medicine and Pharmacy of Rabat, Rabat, Morocco; 5 Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
*Correspondence: Abdelilah Laraqi, Email not available
Abstract
The growing use of antiretroviral therapy (ART) has transformed HIV infection into a chronic, manageable disease, yet the emergence of drug resistance continues to threaten global progress. Morocco, located at the crossroads of Sub-Saharan Africa and Europe, offers a unique context for understanding the molecular evolution of HIV in the Middle East and North Africa. This systematic review synthesizes all available data on HIV-1 genotyping and resistance mutations in Morocco from 2009 to 2024, providing the first national overview of molecular resistance patterns. Six studies comprising 673 individuals met the inclusion criteria, spanning 2004-2015. Subtype B predominated (73.8%), followed by CRF02_AG (17.6%), reflecting increasing viral diversification linked to cross-regional transmission. Among ART-experienced patients, acquired drug resistance reached 19.5% at the population level and 53.3% among successfully sequenced samples, with NRTI (48.9%) and PI (22.2%) mutations predominating. The most frequent mutations were M184V (44%), K103N (8.9%), and V82A/L (13.3%). In ART-naïve individuals, transmitted resistance remained limited (1.55%), with no major integrase strand-transfer inhibitor mutations detected, though accessory polymorphisms such as L74M/I and E157Q were present in 3-5% of cases. CD4 counts and viral load suppression improved in later cohorts. These findings underline the critical need to re-establish molecular surveillance in Morocco to capture post-2019 resistance dynamics under dolutegravir-based therapy. Strengthening genotypic monitoring and integrating resistance testing into clinical care will be pivotal to preserving long-term ART efficacy and achieving the UNAIDS 95-95-95 and HIV elimination targets by 2030.
