Pre-treatment drug resistance surveillance among ART- Naive HIV-1 patients in Tunisia

Drug resistance to Human Immunodeficiency Virus (HIV) antiretroviral therapy (ART) is a major factor in treatment failure. Resistance monitoring is recommended before initiating ART. However, in Tunisia, the pre-treatment resistance related data are missing. This study aimed to investigate the HIV-1 pre-treatment drug resistance in Tunisia. Viral RNAs were extracted from the plasma samples of 77 ART-naïve patients and used for the sequencing of Reverse Transcriptase (RT) and Protease (PR) regions. 12.9% of variants were shown to have at least one Surveillance Drug Resistance Mutations (SDRM) in RT/PR region. K103N is the most involved SDRM-inducing resistance to NNRTIs (efavirenz, nevirapine, and rilpivirine). In the PR gene, resistance was found in four samples on 46 and 85 codons, affecting the sensitivity for Atazanavir and Lopinavir drugs. The subtying revealed the predominance of the CRF02_AG, followed by the subtype B. This study provides the first baseline information for pre-treatment drug resistance surveillance of HIV-1 variants in Tunisia, which may impede patient management.