Prevalence of primary HIV-1 drug resistance among antiretroviral-naïve individuals in Togo in 2023: a national study

Alassane OURO-MEDELI^1*Roméo Mèdéssè TOGAN²laetitia SERRANO³christelle BUTEL³rogatien ATOUN²frederic YOUA²komlan ALI-EDJE⁴messanh DOUFFAN⁴phyllis EHLAN⁵kokou TEGUENI⁶romaric AMENTI⁶abla ahoefa KONOU⁶mounerou SALOU⁷Didier Koumavi EKOUEVI⁸Martine Peeters³anoumou claver DAGNRA⁹

• ¹2. National AIDS, Viral Hepatitis and sexually transmitted infections Control Program (PNLS-HV-IST), Lomé, Togo, PNLS-HV-IST, Lome, Togo
• ²4. Training and Research Center in Public Health (CFRSP), University of Lomé, Togo, 3. African Center of Research in Epidemiology and Public Health (CARESP), Lomé, Togo, LOME, Togo
• ³Institut de Recherche Pour le Développement (IRD), Montpellier, Languedoc-Roussillon, France
• ⁴2. National AIDS, Viral Hepatitis and sexually transmitted infections Control Program (PNLS-HV-IST), Lomé, Togo, 1. National Reference Laboratory for HIV, Viral Hepatitis and Sexually Transmitted Infections (LNR-VIH-HV-IST), Lomé, Togo, LOME, Togo
• ⁵2. National AIDS, Viral Hepatitis and sexually transmitted infections Control Program (PNLS-HV-IST), Lomé, Togo6. Molecular Biology and Immunology of Laboratory (BIOLIM- FSS/UL), University of Lomé, Togo., 1. National Reference Laboratory for HIV, Viral Hepatitis and Sexually Transmitted Infections (LNR-VIH-HV-IST), Lomé, Togo, LOME, Togo
• ⁶2. National AIDS, Viral Hepatitis and sexually transmitted infections Control Program (PNLS-HV-IST), Lomé, Togo, 6. Molecular Biology and Immunology of Laboratory (BIOLIM- FSS/UL), University of Lomé, Togo., LOME, Togo
• ⁷1. National Reference Laboratory for HIV, Viral Hepatitis and Sexually Transmitted Infections (LNR-VIH-HV-IST), Lomé, Togo. 2. National AIDS, Viral Hepatitis and sexually transmitted infections Control Program (PNLS-HV-IST), Lomé, Togo, 6. Molecular Biology and Immunology of Laboratory (BIOLIM- FSS/UL), University of Lomé, Togo., Lome, Togo
• ⁸4. Training and Research Center in Public Health (CFRSP), University of Lomé, Togo,7. Global Health in the Global South (GHiGS)Team, Bordeaux Population Health Research Center U1219, University of Bordeaux, Inserm, Development Research Institute, Bordeaux, France, 3. African Center of Research in Epidemiology and Public Health (CARESP), Lomé, Togo, LOME, Togo
• ⁹2. National AIDS, Viral Hepatitis and sexually transmitted infections Control Program (PNLS-HV-IST), Lomé, Togo 3. Molecular Biology and Immunology of Laboratory (BIOLIM- FSS/UL), University of Lomé, Togo., 1. National Reference Laboratory for HIV, Viral Hepatitis and Sexually Transmitted Infections (LNR-VIH-HV-IST), Lomé, Togo, Lome, Togo

Word count: Monitoring pre-treatment drug resistance is a priority to assess the emergence of HIV resistance to antiretrovirals, especially in countries where the transition from dolutegravir-based regimens is already effective on a large scale. The aim of this study was to estimate the prevalence of resistance mutations to different classes of antiretrovirals (ARVs) in HIV-1-naïve persons in Togo in 2023.A cross-sectional study was conducted in 30 HIV care centers for people living with HIV in Togo between March and August 2023. Persons newly diagnosed with HIV-1, aged 18 and over and naïve to any ART with a viral load ≥ 6500.00 copies/ml were included for genotypic resistance testing for protease (PR), reverse transcriptase (RT) and integrase (IN) genes using Next-generation sequencing. Mutations were interpreted using the updated Stanford HIVDB and ANRS algorithms after genotypic testing for protease, reverse transcriptase and integrase resistance. Among 376 persons enrolled; resistance analyses were carried out on 321 samples. The median age was 39 years, interquartile range (IQR) [30 -47] and 64.9% were women. No resistance mutations to dolutegravir were detected. However, accessory mutations such as E157Q/E157EQ ( 43/57) andT97A/T97TA (14/57) associated with first-generation integrase inhibitors (raltegravir, elvitegravir) were found in 17.2% of samples. No major mutations were observed in the protease gene. Resistance mutations (T215TS and K70KE) were detected in 0.6% (2/316) for NRTIs and 6.3% (20/316) for NNRTIs. The most frequent NNRTI mutations were K103N (4.4%) and G190A (1.3%). The dominant subtypes were CRF02_AG (64.8%) and CRF06_cpx (12.8%). These results support the continued use of dolutegravir-based regimens in Togo and call for continued monitoring of primary resistance to maintain the effectiveness of therapeutic strategies in Togo.