HIV Drug Resistance Mutations and Subtype Profiles among Pregnant Women of Ho Chi Minh City, South Vietnam

Abstract

According to the latest data released by UNAIDS, the global number of people living with HIV (PLHIV) in 2021 was 38.4 million, with 1.5 million new HIV infections. In different countries, a significant proportion of these cases occur in the adult fertile population aged 15-49 years. According to UNAIDS, Vietnam had a national HIV prevalence of 0.3% of the total population at the end of 2019, with approximately 230,000 PLHIV. The most effective way to prevent mother-to-child transmission of HIV is ART to reduce maternal viral load. HIV-infected pregnant women should undergo monthly monitoring, especially before the expected date of delivery. The aim of our work was to analyze subtypic structure and drug-resistant variants of HIV in pregnant women in Ho Chi Minh City. The study material was blood plasma samples from HIV-infected pregnant women: 31 women showed virological failure of ART, and 30 women had not previously received therapy. HIV-1 genotyping and mutation detection were performed based on analysis of the nucleotide sequences of the pol gene region. More than 98% of sequences genotyped as HIV-1 sub-subtype CRF01_AE. When assessing the occurrence of drug resistance mutations, genetic resistance to any drug was detected in 74.41% (95% CI: 62.71-85.54%) of patients. These included resistance mutations to protease inhibitors in 60.66% (95% CI: 47.31-72.93%) of patients, to NRTIs in 8.20% (95% CI: 2.72-18.10%), and to NNRTIs in 44.26% (95% CI: 31.55-57.52%). Mutations associated with NRTI (2) and NNRTI (8) resistance as well as PI mutations (12), including minor ones, were identified. The high prevalence of drug resistance mutations found in this study among pregnant women, both in therapeutically naive individuals and in patients with virological failure of ART, indicates that currently used regimens in Vietnam are insufficient to prevent vertical HIV infection.

Keywords: HIV; HIV drug resistance; human immunodeficiency virus; laboratory diagnostics; prevent mother-to-child transmission of HIV.

Figure 1

Phylogenetic analysis of viral nucleotide sequences (HIV pol gene fragment) from HIV-infected pregnant women in Vietnam relative to GenBank reference sequences. Reference sequences are designated by GenBank codes indicating the sample genotype. Strains studied in this work are marked as follows: triangles—samples from patients with virologically ineffective ART; circles—samples from patients who had not previously received therapy. Bootstrap values ≥70% are given.

Figure 2

Most common HIV drug resistance mutations to PIs in HIV-infected pregnant women in the Socialist Republic of Vietnam.

Figure 3

Most common HIV drug resistance mutations to NNRTIs in HIV-infected pregnant women in the Socialist Republic of Vietnam.

Figure 4

Overall analysis of multiple mutation profiles by line diagram. Mutation profiles are distributed along the horizontal axis.

Figure 5

Analysis of multiple mutation profiles by line diagram. Therapeutically naive individuals (A) and individuals with failure ART (B). Mutation profiles are distributed along the horizontal axis.