HIV Genetic Diversity, Virological Failure, and Drug Resistance in Libreville, Capital of Gabon, before a Total Dolutegravir-Based Regimen Transition

Context: The Human Immunodeficiency Virus (HIV) continues to be the main public health challenge in Gabon. The latest studies highlight a high rate of virological failure and HIV drug resistance in semi-rural Gabon. In Libreville, virological failure data is sparse, data on HIV drug resistance for the former first line and new first-line regimen is lacking. Methods: Between January 28th, 2019, and January 31st, 2020, we received patient living with HIV (PLWHA) for CD4 counts, HIV-1 viral load, and/or genotyping of HIV-1 mutation drug resistance. We used the BD FACSPresto for CD4 count, the Biocentric Generic HIV viral load test for HIV-1 quantification, and the HIV-1 drug resistance mutation genotyping (ARNS protocol). Results: A total of 1129 HIV-1 patients have been enrolled for this study. The median age was 46 years old and the median of CD4 was 386 cells per cubic millimeter. The virological suppression success was observed at 62.7% of patients on the former first line regimen and 70.6% of the patient on DBR. We successfully amplified and analyzed 76 sequences and noticed the presence of the nineteen different subtypes with the predominance of the subtypes CRF02-AG (37.95%), followed by subtype A (22.3%). For HIV drug resistance analyses, 108 (65.1%) had resistance mutation to nucleoside reverse transcriptase inhibitors (NRTIs); of these, 91 (84%) present M184V/I. When looking for NNRTI mutations, 119 (71.7%) sequences had at least one mutation. Of these, 82 had K103N (68.9%), representing the main NNRTI mutations. The pattern showing the high level of resistance (HLR) in all molecules of NRTIs and NNRTIs, except for the TDF (intermediate resistance) was M41L-E44DL74I-M184-L210W-T215Y-K101P-K103N-V106I. Conclusion: This report paints a picture of a relatively female-dominated HIV-infected Gabonese population with a low level of immunity. The level of drug resistance with the former first-line regimen suggests the need to monitor the drug Dolutegravir resistance.