Assessing Drug Resistance Mutations and Subtypes in HIV- Infected Patients with Virological Failure in Specialist Hospital, Waibagi, Yangon

Kay Thi Aye, Kyi Phyu Aye, Myat Htut Nyunt, Sabai Phyu, Sandar Aung, Wah Wah Aung & Hlaing Myat Thu

Myanmar Health Sciences Research Journal, 2024; 36(1-3): 10-18

Human Immunodeficiency Virus (HIV) is one of the priority public health issues in Myanmar. Drug resistance in HIV is of great concern for the rational choice of antiretroviral therapy (ART). A cross-sectional study was conducted to detect drug resistance in HIV infected patients at the Specialist Hospital, Waibagi, Yangon. HIV patients who have been treated with first-line and second-line combination antiretroviral therapy (cART) and diagnosed as virological with or without clinical treatment failure (TF) with viral load more than 1000 copies/ml from February 2019 to January 2020 were included in this study. HIV RNA was extracted from serum samples, amplified by reverse transcriptase polymerase chain reaction (RT-PCR) and sequenced by Sanger sequen-cing. The sequences were analyzed by the Stanford HIV drug resistance database analysis tool (HIVdb version 8.9-1). Of the 59 eligible patients, 50 RNA samples were successfully amplified with 49 (83.1%) of the pol-PR region and 43 (72.9%) of the pol-RT region.

Globally, 38.4 million people were living with Human Immunodeficiency Virus (HIV) at the end of 2021. An estimated 0.7% of adults aged 15-49 years worldwide are living with HIV, although the burden of the epidemic continues to vary considerably between countries and regions. HIV is one of the priority public health issues in Myanmar, and it has the highest prevalence in the Asia Pacific Region in a key geographical area.

Study population

HIV-1 patients with the age of 18 years and above, any sex and those who have been treated with first-line and second-line cART and diagnosed as virological with or without clinical TF with viral load more than  1000 copies/ml at Specialist Hospital, Waibargi, Yangon during February 2019 to January 2020 were enrolled for the study after obtaining the informed consent. A total of 59 eligible patients consisting 55 patients under first-line cART and 4 patients under second-line cART, were included in the study.

In Myanmar, ART was started in 2003 by the National AIDS Program.¹⁰ Currently, ART is carried out according to the World Health Organization (WHO) guidelines (2017); first-line ART consisting of two NRTIs and one NNRTI for adults.³ In 2016, WHO implemented PDR surveys in 11 countries, including Myanmar. According to WHO PDR surveys, NRTI resistance (1.5%), NNRTI resistance (2.7%) and PI resistance (0.3%) were detected from antiretroviral drug-naive patients in Myanmar.^{3, 10}

The authors thank all participants in this study. We acknowledge the staff from Specialist Hospital, Waigagi and that from Advanced Molecular Research Centre, Department of Medical Research to facilitate this study.

The authors declare that there is no competing interest.

1.       World Health Organization. Global Health Observatory, Summary of global HIV epidermic 2021. Available from: https:// www.who.int/data/gho/data/themes/hiv-aids. [Assessed on 29 June 2023.]

2.       World Health Organization. Guidelines for the clinical management of HIV infection in Myanmar, 5^th edition. National AIDS Programme, Department of Public Health, Ministry of Health and Sports, Myanmar 2017.

3.       World Health Organization. Myanmar HIV country profile 2022. Available from: https://www.who.int/ data/gho/data/themes/ hiv-aids/data-on-the-size-of-the-hiv-aids-epi-demic. [Assessed on 25 on September 2023.]