Undiagnosed Chronic Hepatitis B Infection and HIV Type 1 Drug Resistance Profile in AIDS Patients Receiving Tenofovir-containing Antiretroviral Regimens: Considerations for Monitoring Resistant HIV Variants during Treatment

Background: During antiretroviral therapy (ART), resistant HIV-1 variants may be selected resulting in clinical failure. Co-infection rate of Hepatitis B virus in AIDS patients in Cameroon is 11.8%, but few studies have described the profile of resistance associated mutations (RAMs) in HIV in these patients on first-line ART containing antiviral drugs against hepatitis B infection. Thus, we aimed to determine the rate of HBV infection and profile of HIV-1 RAMs in AIDS patients on ART.

Methods: A cross-sectional study was carried out from November 2013 to April 2014 in two AIDS Treatment Centres in Yaoundé, Cameroon. Ninety-six adult AIDS patients on tenofovir-containing regimens were tested for HBsAg by serology. Direct sequencing of amplicons generated for the HIV-1 protease/reverse transcriptase region, was performed for 21 HIV/HBV co-infected patients. The Stanford HIV Drug Resistance Database tool was used to predict RAMs, and genotyping was determined by phylogeny.

Results: Overall, 21 patients were co-infected with HBV (21.9%). Eighteen (85.7%) of these were infected with recombinant variants, and HIV-1 CRF02_AG was most frequently identified (52.9%), and 15 (71.4%) harboured at least one RAM. Prediction of resistance to NNRTIs was reported in 14 (66.7%), and among 13 (61.9%) to NRTIs, 2 (9.5%) to PIs, and 8 (38.1%) carried Thymidine Analog Mutations (TAMs) of M184VI (61.9%), V75I (23.8%), T215F (23.8%), M41L (19.0%) and K70R (19.0%).

Conclusion: Rate of HBV infection and frequency of HIV-1 RAMs among AIDS patients on ART is high. The observed NNRTI RAMs may affect the susceptibility of efavirenz. Thus, the need to monitor HIV-1 drug resistance profile during treatment with unsuppressed viral load.