Prevalence of primary and secondary resistant mutations to antiretroviral drug in a population of Puerto Rican infected with HIV

RESUMO

INTRODUCTION: Several studies have reported increasing number of therapeutic failures with HAART in HIV-infected individuals. In order to assess the impact HIV antiretroviral resistance could have on treatment, we decided to determine the prevalence of primary and secondary antiretroviral resistant genotypes in a population of HIV-infected Puerto Ricans and compare the mutational distribution pattern with that reported in Europe and US. METHOD: In a total of 80 plasma samples from patients with detectable viral load of over 1,000 RNA copies/ml, the Trugene Visible Genetics HIV sequencing method was used to detect antiretroviral resistance mutations. RESULTS: We found 55 subjects (69 per cent) with high level of resistance to ZDV in the reverse transcriptase gene and 46 subjects (58 per cent) with high level of resistance to NFV in the protease gene. Mutation frequencies to the NRTI ranged in appearance from as high as 54 per cent (i.e., M184V) in the studied subjects to a low of less than 5 per cent (i.e., M184I and V75T). For the NNRTI the most common mutation was K103N in 40 per cent of the subjects and found to confer cross resistance to NVP, DLV and EFV. Another concerning finding is the increasing trend of the frequency of primary and secondary resistant mutations from year 2000 to 20001. Nine (23 per cent) of the total detected primary mutations, to either RTI or PI, showed an increase of at least 5 per cent from one year to the other. Similarly, there were 6 (11 per cent) secondary resistant mutations showing an increase of at least 5 per cent during the two years studied. CONCLUSIONS: In two year period we detected a tendency to increase in primary and secondary HIV-resistant mutation in a population of HIV-infected Puerto Ricans.