High prevalence of genotypic and phenotypic HIV-1 drug-resistant strains among patients receiving antiretroviral therapy in Abidjan, Côte d'Ivoire.

To describe prevalence of antiretroviral (ARV) drug-resistant HIV-1 strains among patients with a history of earlier treatment with ARV drugs in Abidjan Cote dIvoire the authors determined mutations that confer HIV-1 ARV drugs resistance by sequencing the viral reverse-transcriptase and protease genes derived from plasma viral RNA of 68 individuals consecutively enrolled in the Joint UN Program on AIDS Drug Access Initiative with a history of earlier ARV drug treatment in Abidjan between August 1998 and April 1999. Phenotypic ARV drug resistance was assessed using a recombinant virus assay. Primary mutations associated with ARV drug resistance to at least one of the reverse-transcriptase inhibitors or protease inhibitors were detected in 39 (57.4%) of the 68 patients. The prevalence of mutations associated with resistance to ARV drugs was: 29 (42.6%) to zidovudine 10 (14.7%) to lamivudine 1 (1.5%) to didanosine 1 K103N mutation (associated with resistance to delavirdine nevirapine and efavirenz) 1 Y181C mutation (associated with resistance to delavirdine and nevirapine) 2 to both indinavir (M46I/L and V82A) and saquinavir (G48V and L90M) and 1 each to ritonavir (V82A) and nelfinavir (D30N). Phenotypic resistance to at least 1 non-nucleoside reverse transcriptase inhibitor (RTI) was seen in 25 (39.7%) patients to non-nucleoside RTIs in 5 (8%) patients and to protease inhibitors in 4 (6%) patients. The high prevalence the authors observed in this study may limit in future the effectiveness of ARV programs in the Cote dIvoire. (authors)