Evidence of HIV-1 Genital Shedding after One Year of Antiretroviral Therapy in Females Recently Diagnosed in Bamako, Mali

Abdelaye Keita; Josselin Rigaill; Sylvie Pillet; Youssouf Sereme; Souleymane Coulibaly; Fodé Diallo; Paul Verhoeven; Bruno Pozzetto; Tenin Aoua Thiero; Thomas Bourlet

doi:10.3390/microorganisms9102164

Evidence of HIV-1 Genital Shedding after One Year of Antiretroviral Therapy in Females Recently Diagnosed in Bamako, Mali

Microorganisms. 2021 Oct 17;9(10):2164. doi: 10.3390/microorganisms9102164.

Authors

Abdelaye Keita^{1

2}, Josselin Rigaill^{2

3}, Sylvie Pillet^{2

3}, Youssouf Sereme², Souleymane Coulibaly¹, Fodé Diallo⁴, Paul Verhoeven^{2

3}, Bruno Pozzetto^{2

3}, Tenin Aoua Thiero¹, Thomas Bourlet^{2

3}

Affiliations

¹ Département Qualité Sécurité et Sûreté Biologique, Institut National de Recherche en Santé Publique (INRSP), Bamako BP 1771, Mali.
² GIMAP Team 15, Inserm, U1111, CNRS, UMR5308, Centre International de Recherche en Infectiologie, Faculty of Medicine, University of Lyon 1, 42000 Saint-Etienne, France.
³ Laboratoire des Agents Infectieux et d'Hygiène, Biology Pathology Department, University Hospital of Saint-Etienne, 42000 Saint-Etienne, France.
⁴ Centre d'Ecoute de Soins et d'Accompagnement (CESAC), ARCAD/SIDA Clinic, Bamako BPE 2561, Mali.

Abstract

Little is known about the dynamic of HIV-1 shedding and resistance profiles in the female genital reservoir after antiretroviral therapy (ART) initiation in resource-limited countries (RLCs), which is critical for evaluating the residual sexual HIV-1 transmission risk. The present study aimed to evaluate the efficacy of 1 year duration ART at blood and genital levels in females newly diagnosed for HIV-1 from three centers in Bamako, Mali. Seventy-eight consenting females were enrolled at the time of their HIV-1 infection diagnosis. HIV-1 RNA loads (Abbott Real-Time HIV-1 assay) were tested in blood and cervicovaginal fluids (CVF) before and 12 months after ART initiation. Primary and acquired resistances to ART were evaluated by Viroseq^TM HIV-1 genotyping assay. The vaginal microbiota was analyzed using IonTorrent^TM NGS technology (Thermo Fisher Scientific). Proportions of primary drug resistance mutations in blood and CVF were 13.4% and 25%, respectively. Discrepant profiles were observed in 25% of paired blood/CVF samples. The acquired resistance rate was 3.1% in blood. At month 12, undetectable HIV-1 RNA load was reached in 84.6% and 75% of blood and CVF samples, respectively. A vaginal dysbiosis was associated with HIV RNA shedding. Our findings emphasize the need of reinforcing education to improve retention in care system, as well as the necessity of regular virological monitoring before and during ART and of implementing vaginal dysbiosis diagnosis and treatment in RLCs.

Keywords: HIV-1; Mali; antiretroviral therapy; genital reservoir; microbiota; resistance.