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JAC Advance Access originally published online on January 24, 2008
Journal of Antimicrobial Chemotherapy 2008 61(3):694-698; doi:10.1093/jac/dkm515
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© The Author 2008. Published by Oxford University Press on behalf of the British Society for Antimicrobial Chemotherapy. All rights reserved. For Permissions, please e-mail: journals.permissions@oxfordjournals.org

Original research

Subtype variability, virological response and drug resistance assessed on dried blood spots collected from HIV patients on antiretroviral therapy in Angola

Carolina Garrido1, Natalia Zahonero1, Diana Fernándes2, Dulcelina Serrano3, Ana Rita Silva2, Nelia Ferraria2, Francisco Antúnes2, Juan González-Lahoz1, Vincent Soriano1 and Carmen de Mendoza1,*

1 Department of Infectious Diseases, Hospital Carlos III, Madrid, Spain 2 Faculty of Medicine and Department of Infectious Diseases, Hospital Santa María, Lisbon, Portugal 3 HIV Unit, Hospital Esperança, Luanda, Angola

Received 11 August 2007; returned 26 November 2007; revised 8 October 2007; accepted 5 December 2007


*Correspondence address. Department of Infectious Diseases, Hospital Carlos III, Sinesio Delgado 10, 28029 Madrid, Spain. Tel: +34-91-4532500; Fax: +34-91-7336614; E-mail: cmendoza{at}teleline.es

Background: Subtype variability may influence treatment response and selection of drug resistance mutations in HIV-positive patients on antiretroviral therapy.

Patients and methods: A retrospective study was performed on specimens collected on dried blood spots (DBS) from HIV-positive individuals receiving antiretroviral therapy in Luanda, Angola. HIV-RNA, drug resistance mutations and subtypes were examined in 294 HIV-positive patients treated with two nucleoside analogues (NA) plus one non-nucleoside reverse transcriptase inhibitor (NNRTI).

Results: Overall, 217 (74%) had <1000 HIV-RNA copies/mL after a median of 12 months (range 7–24) of therapy. CD4 count was significantly higher in subjects with undetectable viraemia compared with viraemic patients (294 versus 220 cells/mm3; P = 0.003). Reverse transcriptase and/or gp41 genes could be genotyped in only 45 (58%) of viraemic patients, probably due to poor storage conditions of DBS. The most frequent resistance mutations were M184V (70%) and K103N (39%); 65% had mutations conferring resistance to both NA and NNRTI. Only five patients did not show resistance mutations. A wide HIV-1 subtype heterogeneity was found: 6 C (18.2%), 2 F (6%), 2 H (6%), 1 D (3%), 1 G (3%), 8 CRF02_AG (24.2%), 2 CRF06 (6%), 1 CRF01_AE (3%), 1 CRF14_BG (3%), 1 CRF25 (3%) and 1 CRF19 (3%). HIV clade could not be assigned in 7 (21%).

Conclusions: Nearly three-quarters of HIV-positive individuals who began an NNRTI-based triple regimen in Angola showed undetectable viraemia after a median of 12 months of therapy, a rate similar to that reported in Western countries. Specimens collected on DBS may allow monitoring of treatment response in resource-limited regions, although adequate temperature and humidity storage conditions are important to ensure RNA stability and further successful testing.

Keywords: DBS , viral load , HIV subtypes , non-B subtypes


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