ABSTRACT
Transmitted drug resistance mutations (TDRM) have been a constant threat to treatment efficacy. We evaluated TDRM in plasma RNA of 217 antiretroviral therapy-naive patients from sites in the São Paulo metropolitan area, collected from 2012 to 2014. The partial HIV-1 polymerase region was sequenced using Big Dye terminators at an ABI 3130 Genetic Analyzer. TDRM was defined according to the Stanford database calibrated population resistance (CPR v.6.0), but other drug resistance mutations (DRM) considered at the IAS list (IAS, 2014) and at the Stanford HIV Database Genotyping Resistance Interpretation (GRI-HIVdb) were also described. Out of 78% (170/217) of patients with information on the time of diagnosis, most (83%, 141/170) had been recently diagnosed, with the first positive HIV serology at a median of 58 days (IQR 18-184). Subtype B predominated (70%), followed by subtype F (10%), BF (7.5%), C (7.5%), and BC (5%). TDRMs were observed in 9.2% (20/217, CI 95% 5.9% to 13.6%), mostly (5.2%) to nonnucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral class. Among children and adolescents, only a single patient showed TDRMs. Additional non-CPR mutations were observed: 11.5% (25/217) according to IAS or 4.6% (10/217) according to GRI-HIVdb. Overall, 23.5% (51/217) of the cases had one or more DRM identified. TDRM prevalence differed significantly among some sites. These trends deserve continuous and systematic surveillance, especially with the new policies of treatment as prevention being implemented in the country.
Subject(s)
Brazil , Humans , Drug Resistance , HIV Infections , Child , Child, Preschool , Adolescent , HIV , Disease Transmission, Infectious , Adult , pol Gene Products, Human Immunodeficiency Virus , GenotypeABSTRACT
Crianças e adolescentes em uso de terapia antirretroviral de alta atividade(HAART) caracterizam um grupo especialmente vulnerável no contexto daepidemia pelo HIV-1...O presente estudo tem como objetivo avaliar os genes da protease e transcriptase reversa em crianças e adolescentes vivendo comHIV/aids. Foi realizada uma análise retrospectiva... Entre os pacientes expostos às três classes com mais de uma entrada (n=27), não houve aumento de mutação para essas classes em relação a genotipagemimediatamente anterior. A alta proporção de resistência aos IP em subtipos Fobservada nesse estudo sugere que o uso dos IP deve ser avaliado levandoem consideração o possível impacto na resposta terapêutica. Os dadosdesse estudo demonstram uma taxa intermediária de resistência transmitidae uma elevada proporção de casos com resistência entre os pacientes emfalha, embasa a noção de que esta população representa um segmento derisco para a evolução da doença.
Children and adolescents on highly active antiretroviral therapy (HAART)represents a vulnerable group in the context of the HIV-1 epidemic, due tobiological issues and different socio-behavioral aspects such as those relatedto adherence to HAART... A retrospective analysis was made, in samples collected from naïve patients and patients exposed to antiretrovirals(ART) with virological failure...Among patients exposed to the three ART classes with more than one genotyping test (n=27), mutations prevalence seemed to not increase when we compared with the previous genotyping test, however most of patients samples showed resistance to the main ART available for use. The high proportion of resistance to IP among subtype F suggests thatin these cases, the IP administration should be evaluated considering apossible impact on therapeutic response. Our results showed an intermediaterate of transmitted resistance e a high proportion of resistance amongpatients with virological failure, supporting the fact that this populationrepresents more risk to disease progression.