First report of computational protein-ligand docking to evaluate susceptibility to HIV integrase inhibitors in HIV-infected Iranian patients

Evaluating HIV drug resistance in the middle East and North Africa and its associated factors: a systematic review

OBJECTIVE

One of the obstacles to achieving successful treatment of HIV infections is the development and spread of mutations linked to resistance. Thus, it is important to monitor the prevalence and occurrence of drug resistance in HIV consistently. This study aimed to investigate how drug resistance affects the effectiveness of ART.

METHODS

This systematic review focused on surveying ART resistance in both treatment-naïve and treatment-experienced PWH from 2004 to 2024.

RESULTS

Out of 101 potential publications, 41 studies were included in this review. ART-experienced PWH in MENA countries commonly receive a regimen consisting of two NRTI drugs in combination with one NNRTI drug. The most frequent mutations were found in NRTIs (M184V, D67N, V75M, M41L, and T69N), NNRTIs (K103N, K101E, V106A, and G190S), and PIs (M36I and H69K). The ART-experienced groups in Israel and Iran presented the highest rates of resistance, reaching 52.78% and 43.03%, respectively, whereas the ART-naïve group in Turkey presented a resistance rate of 53.57%. The most prevalent HIV-1 subtypes in the region were B, CRF35-AD, CRF01-AE, A1, CR02-AG, C, and D. A high frequency of drug resistance mutations, such as M184V and K103N/S, was observed in the CRF35-AD, A, and C subtypes.

CONCLUSION

This is the first report to provide deep insight into ART resistance patterns in the MENA region among both ART-naïve and ART-experienced PWH. The results revealed a significant occurrence of drug resistance to RTIs, PIs, and INSTIs among both groups. This finding highlights the importance of prescribing the INTIs in native and PWH with resistance to RTIs and/or PIs to increase the chance of response to ART as well as regular monitoring of resistance to ART in MENA countries. This also involves identifying the key factors contributing to drug resistance, including inadequate adherence to ART and a lack of adequate monitoring systems to prevent treatment failure. Since the MENA region is significant as an economic challenge, PWH with poor adherence to ART medication and insufficient monitoring systems may hinder successful infection control; therefore, HIV control strategies may prevent viruses from spreading in other countries.

CLINICAL TRIAL NUMBER

Not applicable.

In silico analysis of human herpes virus-8 genome: a comparison of the K1, VR1, and VR2 regions for genotyping and global geographical distribution

Investigations of the K1 gene revealed six main genotypes clustered according to geography. Here, the global distribution and HHV8 genotyping using the K1 gene and two hypervariable regions (VR1 and VR2) were evaluated. We searched GenBank for 6,889 HHV8-K1 genes via various keywords, selecting sequences longer than 730 bp. Afterwards, the VR1 and VR2 regions were derived from the K1 genes, and genotyping of the K1, VR1, and VR2 sequences was performed by applying phylogenetic tree and BioAfrica methods. The K1 genotyping result was most similar to that of VR1, followed by VR2. The most common genotypes and subtypes in the three regions studied were A (A2) and C (C3), which are found in Africa, America, and Asia. Although the A and C genotypes are more predominant, the other genotypes, B, D, E, and F, are more ancient and are commonly found in America, Asia, and Oceania. K1 is commonly used for HHV8 genotyping, but VR1 can be a reliable alternative when long-term PCR amplification is not possible. The genotyping and subtyping results of both methods were very similar (92%), and it can be inferred that both procedures can be applied for HHV-8 genotyping.

HIV-1 reverse transcriptase subtyping revealed CRF35-AD as a current subtype in the northeast of Iran

Previously, the sequence of the HIV-1 reverse transcriptase gene was analyzed to identify mutations associated with drug resistance. We statistically analyzed the relationship between a set of additional data and increasing mutations. Existing sequences were also phylogenetically analyzed. Of all patients tested for phylogenetic tree analysis, one individual had the F subtype, two had the CRF01-AE strain, and two had the A subtype. Phylogenetic tree analysis revealed that HIV-1 CRF35-AD was the most prevalent subtype (88.6%) among the cases studied. The number of treatment discontinuations (r=0.621, df=20, p=0.002) and the duration of treatment (r=0.452, df=20, p=0.035) were significantly correlated with an increase in mutations.

Design of multivalent-epitope vaccine models directed toward the world's population against HIV-Gag polyprotein: Reverse vaccinology and immunoinformatics

Significant progress has been made in HIV-1 research; however, researchers have not yet achieved the objective of eradicating HIV-1 infection. Accordingly, in this study, eucaryotic and procaryotic in silico vaccines were developed for HIV-Gag polyproteins from 100 major HIV subtypes and CRFs using immunoinformatic techniques to simulate immune responses in mice and humans. The epitopes located in the conserved domains of the Gag polyprotein were evaluated for allergenicity, antigenicity, immunogenicity, toxicity, homology, topology, and IFN-γ induction. Adjuvants, linkers, CTLs, HTLs, and BCL epitopes were incorporated into the vaccine models. Strong binding affinities were detected between HLA/MHC alleles, TLR-2, TLR-3, TLR-4, TLR-7, and TLR-9, and vaccine models. Immunological simulation showed that innate and adaptive immune cells elicited active and consistent responses. The human vaccine model was matched with approximately 93.91% of the human population. The strong binding of the vaccine to MHC/HLA and TLR molecules was confirmed through molecular dynamic stimulation. Codon optimization ensured the successful translation of the designed constructs into human cells and E. coli hosts. We believe that the HIV-1 Gag vaccine formulated in our research can reduce the challenges faced in developing an HIV-1 vaccine. Nevertheless, experimental verification is necessary to confirm the effectiveness of these vaccines in these models.

Reverse vaccinology approaches to design a potent multiepitope vaccine against the HIV whole genome: immunoinformatic, bioinformatics, and molecular dynamics approaches

Substantial advances have been made in the development of promising HIV vaccines to eliminate HIV-1 infection. For the first time, one hundred of the most submitted HIV subtypes and CRFs were retrieved from the LANL database, and the consensus sequences of the eleven HIV proteins were obtained to design vaccines for human and mouse hosts. By using various servers and filters, highly qualified B-cell epitopes, as well as HTL and CD8 + epitopes that were common between mouse and human alleles and were also located in the conserved domains of HIV proteins, were considered in the vaccine constructs. With 90% coverage worldwide, the human vaccine model covers a diverse allelic population, making it widely available. Codon optimization and in silico cloning in prokaryotic and eukaryotic vectors guarantee high expression of the vaccine models in human and E. coli hosts. Molecular dynamics confirmed the stable interaction of the vaccine constructs with TLR3, TLR4, and TLR9, leading to a substantial immunogenic response to the designed vaccine. Vaccine models effectively target the humoral and cellular immune systems in humans and mice; however, experimental validation is needed to confirm these findings in silico.

Frequency of Fusion Inhibitor Resistance Mutations Among Therapy-Naïve HIV Patients

Glycoprotein 41 (gp41) of the human immunodeficiency virus type 1 (HIV-1) protein plays a critical role in membrane fusion. Gp41 binds to proteins in the plasma membrane of CD4+ T cells, particularly the T-cell antigen receptor (TCR). These findings indicate that gp41 is involved in the assembly of HIV-1 at the plasma membrane of T cells and affects the stimulation of the TCR. To control HIV-1, new inhibitors were introduced to target the gp41 protein. However, mutations in this region might reduce their efficacy. The Gp41 region was amplified from the sera of 30 patients using nested polymerase chain reaction. The sequences were analyzed by bioinformatics tools to identify mutations and gp41 structural features. Subtyping and the interaction between fusion inhibitors and gp41 proteins were also examined. As the first report from Iran, docking analysis between fusion inhibitors and Iranian gp41 proteins showed that mutations in gp41 could not reduce the efficacy of the fusion inhibitors. Most of the patients were infected with CRF35-AD. Several post-modification positions, including glycosylation and phosphorylation sites, were identified in the gp41 protein. Our findings revealed no known multinational drug resistance to gp41 inhibitors; thus, fusion inhibitors can effectively inhibit HIV in Iranian patients. In addition, the present study introduced a new gp41 region (36-44 aa), which considerably influences the interactions between gp41 inhibitors and the gp41 protein. This region may play a pivotal role in suppressing gp41 inhibitors in CFR35-AD. Furthermore, gp41 can be considered a good target for subtyping analysis via the phylogenetic method.

Predictors of antiretroviral treatment failure to the first line therapy: a cross-sectional study among Iranian HIV-positive adults

BACKGROUND

HIV virological failure is one of the main problems in HIV-infected patients, and identifying the main predictors of such treatment failure may help in combating HIV/AIDS.

METHODOLOGY

This cross-sectional study included 1800 HIV-infected patients with either virological failure or treatment response. HIV viral load, CD4 count, and other tests were performed. Statistical analysis was used to determine the predictors of virological failure.

RESULTS

Clinical stage, treatment with reverse transcriptase inhibitors (RTIs), under therapy for three years or more, suboptimal adherence to antiretroviral treatment (ART), age > 40 years, CD4 count < 200 cells/mm3, unemployment, being infected through sex, and the presence of symptoms were the predominant risk factors for virological failure. In addition, 55% of patients who experienced virological failure failed to experience immunological and/or clinical failure.

CONCLUSION

As the first study in southern Iran and the second in Iran, Iranian policymakers should focus on intensive counseling and adherence support and emphasize more effective treatment regimens such as protease and integrase inhibitors (PIs and INTIs), to increase the chance of a treatment response to ART. The accuracy of identifying clinical and immunological criteria in resource-limited settings is not promising. The present findings can be used to determine effective measures to control HIV treatment failure and design efficient strategies for the ambitious 95-95-95 plan.

Transmitted Drug Resistance Against Integrase Strand Transfer Inhibitors in Iranian HIV-Infected Naïve Patients

Background

Human Immunodeficiency Virus (HIV) has claimed the lives of millions of people during the past decades. While several antiretroviral drugs like Integrase Strand Transfer Inhibitors (INSTIs) have been introduced to control HIV, Transmitted Drug Resistance (TDR) in HIV genome caused failure in treatment. This study aimed to investigate TDR and natural occurring mutations (NOPs) in HIV integrase gene in Iranian HIV patients.

Methods

In this cross-sectional study, blood samples of 30 HIV-positive patients who had never taken integrase inhibitors were considered for CD4 T cell count, RT real-time PCR, and, Nested PCR. The sequencing results were analyzed by CLC sequence viewer software and Stanford University HIV Drug Resistance Database.

Results

In all samples, nine NOPs with a high prevalence were found; however, we did not find any drug resistance mutations, except for a mutation in one sample, which showed a low resistance level. Subtype A1 was dominant in all samples.

Conclusion

Based on the findings and compared to our previous study, all patients were sustainable to main integrase inhibitors, including bictegravir, raltegravir, bictegravir, elvitegravir and dolutegravir. It seems the resistant mutation pattern attributed to integrase inhibitors was not diffent among studied patients; hence, the prescription of such inhibitors helps physicians to control HIV infection in Iranian HIV-infected patients.

A computational overview of integrase strand transfer inhibitors (INSTIs) against emerging and evolving drug-resistant HIV-1 integrase mutants

AIDS (Acquired immunodeficiency syndrome) is one of the chronic and potentially life-threatening epidemics across the world. Hitherto, the non-existence of definitive drugs that could completely cure the Human immunodeficiency virus (HIV) implies an urgent necessity for the discovery of novel anti-HIV agents. Since integration is the most crucial stage in retroviral replication, hindering it can inhibit overall viral transmission. The 5 FDA-approved integrase inhibitors were computationally investigated, especially owing to the rising multiple mutations against their susceptibility. This comparative study will open new possibilities to guide the rational design of novel lead compounds for antiretroviral therapies (ARTs), more specifically the structure-based design of novel Integrase strand transfer inhibitors (INSTIs) that may possess a better resistance profile than present drugs. Further, we have discussed potent anti-HIV natural compounds and their interactions as an alternative approach, recommending the urgent need to tap into the rich vein of indigenous knowledge for reverse pharmacology. Moreover, herein, we discuss existing evidence that might change in the near future.