Transmitted Drug Resistance Patterns and Molecular Surveillance among Antiretroviral-Naive Adults with Acute HIV-1 Infection

International Journal of Medicine and Medical Sciences | Vol. 16, No. 7, July 2026 | pp. 49–56

DOI: 10.46882/2026/IJMMS/160049

Original Research Article

Transmitted Drug Resistance Patterns and Molecular Surveillance among Antiretroviral-Naive Adults with Acute HIV-1 Infection

Patrick O. Diallo¹, Cynthia U. Nwachukwu², Jean-Pierre B. Diop¹*

¹Department of Infectious Diseases, Faculty of Medicine, Université Cheikh Anta Diop, Dakar, Senegal.

²Department of Medicine, University of Nigeria Teaching Hospital, Ituku-Ozalla, Enugu, Nigeria.

Abstract:

The transmission of drug-resistant HIV-1 strains threatens the long-term clinical efficacy of standard first-line antiretroviral therapy (ART) regimens. This prospective molecular surveillance study evaluated the prevalence of transmitted drug resistance (TDR) and characterized specific mutations among treatment-naive adult patients diagnosed with acute HIV-1 infection. Blood samples from 220 newly diagnosed, baseline ART-naive participants were collected. Viral RNA was extracted, and the pol gene (protease and partial reverse transcriptase regions) was amplified via nested PCR and sequenced using Sanger sequencing methods. Major drug resistance mutations were identified according to the World Health Organization (WHO) surveillance definitions. The overall prevalence of TDR in this cohort was found to be 11.8% (26/220). Resistance mutations directed against non-nucleoside reverse transcriptase inhibitors (NNRTIs) predominated, accounting for 7.3% of the total cohort, with the K103N (42.3%) and V106M (26.9%) substitutions being the most frequent. Nucleoside reverse transcriptase inhibitor (NRTI) mutations (M184V and T215Y) were detected in 3.2% of the participants, while protease inhibitor (PI) resistance remained low at 1.4%. Molecular genotypic routing showed a high prevalence of the CRF02_AG recombinant form (68.5%). Multivariate logistic regression modeling demonstrated that an age under 25 years (OR = 3.2, 95% CI = 1.5–6.8, p < 0.01) was an independent clinical risk factor for harboring a resistant variant. The TDR prevalence has crossed the intermediate threshold in this urban environment, driven by NNRTI-resistant clones. Baseline genotype tracking is recommended to preserve therapeutic outcomes.

Keywords: HIV-1, Transmitted Drug Resistance, Reverse Transcriptase, Genotype Surveillance, CRF02_AG, Molecular Mutations

Manuscript Timeline: Received: April 14, 2026; Revised: May 22, 2026; Accepted: June 10, 2026; Published: July 14, 2026.

Citation: Diallo PO, Nwachukwu CU, Diop JPB. Transmitted Drug Resistance Patterns and Molecular Surveillance among Antiretroviral-Naive Adults with Acute HIV-1 Infection. International Journal of Medicine and Medical Sciences, 2026, 16(7): 49–56. DOI: 10.46882/2026/IJMMS/160049

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