Genotypic patterns of HIV-1 drug resistance mutations in Ethiopian patients with first-line ART failure

Abstract

Antiretroviral therapy (ART) has revolutionized the management of HIV/AIDS, yet the emergence of drug resistance mutations remains a significant concern. This study aimed to characterize drug resistance mutations among patients failing first-line antiretroviral treatment in Ethiopia. A total of 52 HIV-infected patients who experienced first-line ART failure were recruited between March 2020 - March 2021 from selected hospitals of Amhara and Oromiya regions. The viral load was measured by Abbott Real-Time HIV-1 automated extraction and detection m2000 system platform (Abbott Molecular Inc., Des Plaines, IL, USA). The partial pol gene region of HIV-1 was amplified and sequenced using an in-house HIV − 1 drug resistance assay. The Stanford HIVDB v9.0 algorithm, and the Calibrated Population Resistance (CPR) Tool and the IAS-USA mutation lists were used to identify mutations conferring resistance. A total of 52 HIV-positive individuals met the study’s inclusion criteria. Genotypic analysis revealed a diverse spectrum of resistance mutations, with the prevalence of potential drug resistance (PDR) reaching 46.2% (24/52) for nucleoside reverse transcriptase inhibitors (NRTIs), 69.2% (36/52) for non-nucleoside reverse transcriptase inhibitors (NNRTIs), and 32.7% (17/52) for protease inhibitors (PIs). The most commonly identified mutations associated with high-level drug resistance included M184V/I, K103N/S, V82I and K20R. This study reveals a significant burden of drug resistance mutations among Ethiopian HIV patients on ART, reinforcing the urgent need for continuous surveillance to inform and strengthen treatment protocols. Targeted interventions—such as pre-treatment resistance testing and individualized regimen optimization—are essential to stem the transmission of resistant HIV strains and safeguard the sustainability of Ethiopia’s ART programs.