Genotypic and Phenotypic Analyses of Human Immunodeficiency Virus Type 1 in Antiretroviral Drug-naive Nigerian Patients

We analyzed the subtypes and genotypic and phenotypic drug susceptibility profiles of 18 HIV-1 isolates from treatment-naive patients in Nigeria. A modified gp41-based heteroduplex mobility assay was used to determine the clade designation based on the envelope gene. The protease and most of the reverse transcriptase regions were cloned into a retroviral expression vector and sequenced. Samples were also analyzed phenotypically using a rapid phenotypic assay (PhenoSense HIV, ViroLogic, Inc.). According to the modified gp41-based heteroduplex mobility assay, the patients were infected with either clade G (17 specimens) or clade A (one specimen) isolates. From phylogenetic analyses of 1212 nucleotides of the polymerase gene, 14 of the 18 isolates were strongly grouped with subtype G reference strains. The remaining four isolates were grouped with the CRF_02_AG clade. Within the protease region, all 18 isolates had mutations/polymorphic substitutions at six locations compared to the HIV-1 NL4-3 reference sequence, two of which have been associated with resistance to protease inhibitors (K20I and M36I). At least half of the isolates had mutations/polymorphic substitutions at an additional five positions in the protease region. Within the reverse transcriptase (RT) region, all 18 isolates showed an E291D mutation/polymorphic substitution. Mutations/polymorphic substitutions were also found in at least half of the isolates at 21 positions. The phenotypic profiles of the viruses correlated well with the observed genotypes. Two isolates showed slightly reduced susceptibility to one or two of the five PIs assessed (ritonavir and ritonavir/nelfinavir) and all 18 viruses were susceptible to all NRTIs and NNRTIs analyzed.