Open AccessHigh frequency of antiviral drug resistance and non‐b subtypes in HIV‐1 patients failing antiviral therapy in Cuba
Author(s) -
Kouri Vivian,
Alemán Yoan,
Pérez Lissette,
Pérez Jorge,
Fonseca Carlos,
Correa Consuelo,
Aragonés Carlos,
Campos Jorge,
Álvarez Delmis,
Schrooten Yoeri,
Vinken Lore,
Limia Celia,
Soto Yudira,
Vandamme AnneMieke,
Van Laethem Kristel
Publication year - 2014
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.17.4.19754
Subject(s) - medicine , antiviral therapy , drug resistance , human immunodeficiency virus (hiv) , drug , antiviral drug , pharmacotherapy , virology , immunology , pharmacology , virus , microbiology and biotechnology , biology , chronic hepatitis
Emergence of HIV‐1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options. The objective is to implement the surveillance of drug resistance and subtypes in HIV‐1 patients failing ART in Cuba. Methods This study compiled clinical and genotypic drug resistance data 588 ART‐experienced HIV‐1 patients attending a clinical center in Havana in 2009–2013. Drug resistance testing was performed as part of routine clinical care. Drug resistance mutations and levels were determined using Rega version 8.0.2. Results Eighty‐three percent received solely ART containing at least three drugs. Patients from 2009 to 2010 were longer treated (median: 4.9 vs 2.7 years) and exposed to more ART regimens (median: 4 vs 2 regimens) compared to patients from 2011–2013. Nucleoside reverse transcriptase inhibitor (NRTI), non‐nucleoside RTI (NNRTI) and PI mutations were present in 83.5, 77.4 and 52.0%. Full‐class resistance (FCR) to NRTI, NNRTI, PI and multidrug resistance (MDR) were detected in 25.0, 33.7, 11.4 and 6.3%. FCR to NRTI, NNRTI, PI and MDR were present in 12.8, 28.7, 0 and 0% after first‐line failure (164 patients) and in 23.1, 34.6, 3.8 and 3.1% after second‐line failure (130 patients). Subtype B (32.5%), BG recombinants (19.6%) and CRF19_cpx (16.2%) were the most prevalent genetic forms. Subtype distribution did not change significantly between 2009–2010 and 2011–2013, except for BG recombinants that increased from 12.2 to 21.3% (p=0.002). Conclusions Our study found a high prevalence of drug resistance and supports the need for appropriate laboratory monitoring in clinical practice and access to drug options in case of virological failure.