Open AccessHIV‐1 drug resistance‐associated mutations among antiretroviral‐naïve Thai patients with chronic HIV‐1 infection
Author(s) -
Manosuthi W,
Thongyen S,
Nilkamhang S,
Manosuthi S,
Sungkanuparph S
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 - 10.7448/ias.15.6.18203
Subject(s) - medicine , resistance mutation , drug resistance , human immunodeficiency virus (hiv) , virology , viral load , genotype , protease , antiretroviral therapy , reverse transcriptase , gene , microbiology and biotechnology , biology , polymerase chain reaction , enzyme , genetics , biochemistry
Purpose of study Antiretroviral therapy (ART) has been scaled up in resource‐limited settings. This study aimed to determine the prevalence of HIV‐1 drug resistance‐associated mutations (DRAMs) among patients with chronic HIV‐1 infection and to compare DRAMs between CRF01_AE and B subtypes. Methods ART‐naïve Thai patients who were indicated for ART initiation between 2010 and 2011 were prospectively enrolled. Genotypic assays of reverse transcriptase and protease genes were performed within 4 weeks prior to ART. DRAMs were assessed using International AIDS Society USA 2011 list. Summary of results A total of 330 patients were included. HIV‐1 subtypes included CRF01_AE (241, 73.0%), B (79, 23.9%), and others (10, 3.1%). Median (IQR) CD4 was 66 (23–172) cells/mm 3 and median (IQR) HIV‐1 RNA was 5.2 (4.6–5.8) log copies/mL. The prevalence of patients with≥1 DRAMs to any antiretroviral agents was 17.6%; 17.0% to NNRTIs, 0.6% to NRTIs, and 0.6% to protease inhibitors (PIs). V106I (23, 7.0%), V179D (14, 4.2%), V179T (6, 1.8%), E138A (5, 1.5%), V90I (4, 1.2%), K103N (3, 0.9%), Y181C (3, 0.9%), and P225H (1, 0.3%) were DRAMs to NNRTIs. M184V (1, 0.3%) and T215S (1, 0.3%) were DRAMs to NRTIs. M46L (2, 0.6%) was the only major DRAM to PI. Minor DRAMs to PIs including I13V, M36I, H69K, and L89M were more frequently observed in CRF_01 AE but A71V/T and V77I were more common in subtype B (P < 0.05). By multivariate analysis, the factors ‘HIV‐1 subtype B’ and ‘low pretreated CD4 cell count’ were associated with higher rate of DRAMs. Conclusion HIV‐1 DRAMs, especially to NNRTIs, is emerging in a middle‐income country after a widespread use of NNRTI‐based ART. HIV genotypic assay prior to ART initiation in patients with chronic HIV‐1 infection should be considered.