Open AccessEmergence of HIV‐1 drug resistance mutations among antiretroviral‐naïve HIV‐1‐infected patients after rapid scaling up of antiretroviral therapy in Thailand
Author(s) -
Sungkanuparph Somnuek,
Sukasem Chonlaphat,
Kiertiburanakul Sasisopin,
Pasomsub Ekawat,
Chantratita Wasun
Publication year - 2012
Publication title -
journal of the international aids society
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.724
H-Index - 62
ISSN - 1758-2652
DOI - 10.1186/1758-2652-15-12
Subject(s) - medicine , antiretroviral therapy , human immunodeficiency virus (hiv) , drug resistance , antiretroviral drug , virology , antiretroviral agents , viral load , genetics , biology
Background After rapid scaling up of antiretroviral therapy in HIV‐1‐infected patients, the data of primary HIV‐1 drug resistance in Thailand is still limited. This study aims to determine the prevalence and associated factors of primary HIV‐1 drug resistance in Thailand. Methods A prospective observational study was conducted among antiretroviral‐naïve HIV‐1‐infected Thai patients from 2007 to 2010. HIV‐1 subtypes and mutations were assayed by sequencing a region of HIV‐1 pol gene. Surveillance drug resistance mutations recommended by the World Health Organization for surveillance of transmitted HIV‐1 drug resistance in 2009 were used in all analyses. Primary HIV‐1 drug resistance was defined as the presence of one or more surveillance drug resistance mutations. Results Of 466 patients with a mean age of 38.8 years, 58.6% were males. Risks of HIV‐1 infection included heterosexual (77.7%), homosexual (16.7%), and intravenous drug use (5.6%). Median (IQR) CD4 cell count and HIV‐1 RNA were 176 (42‐317) cells/mm 3 and 68,600 (19,515‐220,330) copies/mL, respectively. HIV‐1 subtypes were CRF01_AE (86.9%), B (8.6) and other recombinants (4.5%). The prevalence of primary HIV‐1 drug resistance was 4.9%; most of these (73.9%) had surveillance drug resistance mutations to only one class of antiretroviral drugs. The prevalence of patients with NRTI, NNRTI, and PI surveillance drug resistance mutations was 1.9%, 2.8% and 1.7%, respectively. From logistic regression analysis, there was no factor significantly associated with primary HIV‐1 drug resistance. There was a trend toward higher prevalence in females [odds ratio 2.18; 95% confidence interval 0.896‐5.304; p = 0.086]. Conclusions There is a significant emergence of primary HIV‐1 drug resistance in Thailand after rapid scaling up of antiretroviral therapy. Although HIV‐1 genotyping prior to antiretroviral therapy initiation is not routinely recommended in Thailand, our results raise concerns about the risk of early treatment failure in patients with primary HIV‐1 drug resistance. Interventions to prevent the transmission of HIV‐1 drug resistance and continuation of surveillance for primary HIV‐1 drug resistance in Thailand are indicated.