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Machado LY, Blanco M, López LS, Díaz HM, Dubed M, Valdés N, Noa E, Martínez L, Pérez MT, Romay DM, Rivero CB, Joanes J, Cancio I, Lantero MI, Rodríguez M. National survey of pre-treatment HIV drug resistance in Cuban patients. PLoS One 2019; 14:e0221879. [PMID: 31479466 PMCID: PMC6719847 DOI: 10.1371/journal.pone.0221879] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 08/17/2019] [Indexed: 11/22/2022] Open
Abstract
Background The World Health Organization (WHO) recommends a method to estimate nationally representative pretreatment HIV drug resistance (PDR) in order to evaluate the effectiveness of first -line treatments. The objective of the present study was to determine the prevalence of PDR in Cuban adults infected with HIV-1. Materials and methods A cross-sectional study in Cuban adults infected with HIV-1 over 18 years was conducted. The probability proportional to size method for the selection of municipalities and patients without a prior history of antiretroviral treatment during the period from January 2017 to June 2017 was used. The plasma from 141 patients from 15 municipalities for the determination of viral subtype and HIV drug resistance was collected. Some clinical and epidemiological variables were evaluated. Results 80. 9% of the patients corresponded to the male sex and 76.3% were men who have sex with other men (MSM). The median CD4 count was 371 cells / mm3 and the median viral load was 68000 copies / mL. The predominant genetic variants were subtype B (26.9%), CRF19_cpx (24.1%), CRF 20, 23, 24_BG (23.4%) and CRF18_cpx (12%). Overall, the prevalence of PDR was 29.8% (95%, CI 22.3–38.1). The prevalence was 12.8% (95%, CI 6.07–16.9) for any nucleoside reverse transcriptase inhibitor (NRTI), 23.4% (95%, CI 16.7–31.3) for any non-reverse transcriptase inhibitor (NNRTI) and 1.4% (95%, CI 0.17–5.03) for any protease inhibitor (PI). The most frequent mutations detected were K103N (12.9%), G190A (6.4%) and Y181C (4.8%). Conclusions The NNRTI prevalence above 10% in our study indicates that the first-line antiretroviral therapy in Cuba may be less effective and supports the need to look for new treatment options that contribute to therapeutic success and help the country achieve the global goals 90-90-90 set forth by UNAIDS.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | - José Joanes
- Department of STI/HIV/AIDS, Ministry of Public Health, Havana, Cuba
| | - Isis Cancio
- Department of STI/HIV/AIDS, Ministry of Public Health, Havana, Cuba
| | - María I. Lantero
- Department of STI/HIV/AIDS, Ministry of Public Health, Havana, Cuba
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2
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Vinken L, Fransen K, Cuypers L, Alexiev I, Balotta C, Debaisieux L, Seguin-Devaux C, García Ribas S, Gomes P, Incardona F, Kaiser R, Ruelle J, Sayan M, Paraschiv S, Paredes R, Peeters M, Sönnerborg A, Vancutsem E, Vandamme AM, Van den Wijngaert S, Van Ranst M, Verhofstede C, Stadler T, Lemey P, Van Laethem K. Earlier Initiation of Antiretroviral Treatment Coincides With an Initial Control of the HIV-1 Sub-Subtype F1 Outbreak Among Men-Having-Sex-With-Men in Flanders, Belgium. Front Microbiol 2019; 10:613. [PMID: 30972053 PMCID: PMC6443750 DOI: 10.3389/fmicb.2019.00613] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2018] [Accepted: 03/11/2019] [Indexed: 11/17/2022] Open
Abstract
Human immunodeficiency virus type 1 (HIV-1) non-B subtype infections occurred in Belgium since the 1980s, mainly amongst migrants and heterosexuals, whereas subtype B predominated in men-having-sex-with-men (MSM). In the last decade, the diagnosis of F1 sub-subtype in particular has increased substantially, which prompted us to perform a detailed reconstruction of its epidemiological history. To this purpose, the Belgian AIDS Reference Laboratories collected HIV-1 pol sequences from all sub-subtype F1-infected patients for whom genotypic drug resistance testing was requested as part of routine clinical follow-up. This data was complemented with HIV-1 pol sequences from countries with a high burden of F1 infections or a potential role in the global origin of sub-subtype F1. The molecular epidemiology of the Belgian subtype F1 epidemic was investigated using Bayesian phylogenetic inference and transmission dynamics were characterized based on birth-death models. F1 sequences were retained from 297 patients diagnosed and linked to care in Belgium between 1988 and 2015. Phylogenetic inference indicated that among the 297 Belgian F1 sequences, 191 belonged to a monophyletic group that mainly contained sequences from people likely infected in Belgium (OR 26.67, 95% CI 9.59–74.15), diagnosed in Flanders (OR 7.28, 95% CI 4.23–12.53), diagnosed at a recent stage of infection (OR 7.19, 95% CI 2.88-17.95) or declared to be MSM (OR 34.8, 95% CI 16.0–75.6). Together with a Spanish clade, this Belgian clade was embedded in the genetic diversity of Brazilian subtype F1 strains and most probably emerged after one or only a few migration events from Brazil to the European continent before 2002. The origin of the Belgian outbreak was dated back to 2002 (95% higher posterior density 2000–2004) and birth-death models suggested that its extensive growth had been controlled (Re < 1) by 2012, coinciding with a time period where delay in antiretroviral treatment initiation substantially declined. In conclusion, phylogenetic reconstruction of the Belgian HIV-1 sub-subtype F1 epidemic illustrates the introduction and substantial dissemination of viral strains in a geographically restricted risk group that was most likely controlled by effective treatment as prevention.
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Affiliation(s)
- Lore Vinken
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Katrien Fransen
- AIDS Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Lize Cuypers
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Ivailo Alexiev
- National Reference Confirmatory Laboratory of HIV, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria
| | - Claudia Balotta
- Infectious Diseases and Immunopathology Section, 'L. Sacco' Department of Biomedical and Clinical Sciences, 'L. Sacco' Hospital, University of Milan, Milan, Italy
| | - Laurent Debaisieux
- AIDS Reference Laboratory, CUB-Hopital Erasme, Université Libre de Bruxelles, Brussels, Belgium
| | - Carole Seguin-Devaux
- Laboratory of Retrovirology, Department of Infection and Immunity, Luxembourg Institute of Health, Esch-sur-Alzette, Luxembourg
| | - Sergio García Ribas
- AIDS Reference Laboratory, Department of Clinical Sciences, Institute of Tropical Medicine Antwerp, Antwerp, Belgium
| | - Perpétua Gomes
- Serviço de Patologia Clínica, Laboratorio de Biologia Molecular, LMCBM, Centro Hospitalar Lisboa Ocidental, Hospital Egas Moniz, Lisbon, Portugal.,Centro de Investigação Interdisciplinar Egas Moniz, Instituto Universitário Egas Moniz, Almada, Portugal
| | | | - Rolf Kaiser
- Institute of Virology, University of Cologne, Cologne, Germany
| | - Jean Ruelle
- Unit of Medical Microbiology, Institute of Experimental and Clinical Research, Université catholique de Louvain, Brussels, Belgium
| | - Murat Sayan
- PCR Unit, Clinical Laboratory, Kocaeli University, İzmit, Turkey.,Research Center of Experimental Health Sciences, Near East University, Nicosia, Cyprus
| | - Simona Paraschiv
- Molecular Diagnostics Laboratory, National Institute for Infectious Diseases 'Matei Bals', Bucharest, Romania
| | - Roger Paredes
- IrsiCaixa AIDS Research Institute, Universitat Autònoma de Barcelona, Badalona, Spain
| | - Martine Peeters
- UMI 233 TransVIHMI/INSERM1175, Institut de Recherche pour le Développement, University of Montpellier, Montpellier, France
| | - Anders Sönnerborg
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Ellen Vancutsem
- AIDS Reference Laboratory, Department of Microbiology and Infection Control, Universitair Ziekenhuis Brussel, Brussels, Belgium
| | - Anne-Mieke Vandamme
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,Unidade de Microbiologia, Center for Global Health and Tropical Medicine, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisbon, Portugal
| | - Sigi Van den Wijngaert
- AIDS Reference Laboratory, Department of Microbiology, Saint-Pierre University Hospital, Brussels, Belgium
| | - Marc Van Ranst
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Chris Verhofstede
- AIDS Reference Laboratory, Department of Clinical Chemistry, Microbiology and Immunology, Ghent University, Ghent, Belgium
| | - Tanja Stadler
- Department of Biosystems Science and Engineering, ETH Zürich, Basel, Switzerland.,Swiss Institute of Bioinformatics, Lausanne, Switzerland
| | - Philippe Lemey
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium
| | - Kristel Van Laethem
- Laboratory of Clinical and Epidemiological Virology, Department of Microbiology and Immunology, Rega Institute for Medical Research, KU Leuven, Leuven, Belgium.,AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
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3
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Tamalet C, Tissot-Dupont H, Motte A, Tourrès C, Dhiver C, Ravaux I, Poizot-Martin I, Dieng T, Tomei C, Bregigeon S, Zaegel-Faucher O, Laroche H, Aherfi S, Mokhtari S, Chaudet H, Ménard A, Brouqui P, Stein A, Colson P. Emergence of uncommon HIV-1 non-B subtypes and circulating recombinant forms and trends in transmission of antiretroviral drug resistance in patients with primary infection during the 2013-2015 period in Marseille, Southeastern France. J Med Virol 2018; 90:1559-1567. [PMID: 29797570 DOI: 10.1002/jmv.25228] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Accepted: 05/12/2018] [Indexed: 11/06/2022]
Abstract
Primary HIV-1 infections (PHI) with non-B subtypes are increasing in developed countries while transmission of HIV-1 harboring antiretroviral resistance-associated mutations (RAMs) remains a concern. This study assessed non-B HIV-1 subtypes and RAMs prevalence among patients with PHI in university hospitals of Marseille, Southeastern France, in 2005-2015 (11 years). HIV-1 sequences were obtained by in-house protocols from 115 patients with PHI, including 38 for the 2013-2015 period. On the basis of the phylogenetic analysis of the reverse transcriptase region, non-B subtypes were identified in 31% of these patients. They included 3 different subtypes (3A, 1C, 4F), 23 circulating recombinant forms (CRFs) (CRF02_AG, best BLAST hits being CRF 36_cpx and CRF30 in 7 and 1 cases, respectively), and 5 unclassified sequences (U). Non-B subtypes proportion increased significantly, particularly in 2011-2013 vs in 2005-2010 (P = .03). CRF02_AG viruses largely predominated in 2005-2013 whereas atypical strains more difficult to classify and undetermined recombinants emerged recently (2014-2015). The prevalence of protease, nucleos(t)ide reverse transcriptase, and first-generation nonnucleoside reverse transcriptase inhibitors-associated RAMs were 1.7% (World Health Organization [WHO] list, 2009/2.6% International AIDS Society [IAS] list, 2017), 5.2%/4.3%, and 5.2%/5.2%, respectively. Etravirine/rilpivirine-associated RAM (IAS) prevalence was 4.3%. Men who have sex with men (MSM) were more frequently infected with drug-resistant viruses than other patients (26% vs 7%; P = .011). The recent increase of these rare HIV-1 strains and the spread of drug-resistant HIV-1 among MSM in Southeastern France might be considered when implementing prevention strategies and starting therapies.
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Affiliation(s)
- Catherine Tamalet
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Hervé Tissot-Dupont
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Anne Motte
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Christian Tourrès
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Catherine Dhiver
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Isabelle Ravaux
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Isabelle Poizot-Martin
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Marseille, France.,INSERM U912 SESSTIM, Aix Marseille Université, Marseille, France
| | - Thérèse Dieng
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Christelle Tomei
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Sylvie Bregigeon
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Marseille, France.,INSERM U912 SESSTIM, Aix Marseille Université, Marseille, France
| | - Olivia Zaegel-Faucher
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Marseille, France.,INSERM U912 SESSTIM, Aix Marseille Université, Marseille, France
| | - Hélène Laroche
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Marseille, France.,INSERM U912 SESSTIM, Aix Marseille Université, Marseille, France
| | - Sarah Aherfi
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Saadia Mokhtari
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Hervé Chaudet
- Assistance Publique-Hôpitaux de Marseille (AP-HM), Service d'Immuno-Hématologie Clinique, Hôpital Sainte-Marguerite, Marseille, France
| | - Amelie Ménard
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Philippe Brouqui
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Andreas Stein
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
| | - Philippe Colson
- IRD, APHM, MEPHI, IHU-Méditerranée Infection, Aix Marseille University, Marseille, France
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4
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Sayan M, Sargin F, Inan D, Sevgi DY, Celikbas AK, Yasar K, Kaptan F, Kutlu S, Fisgin NT, Inci A, Ceran N, Karaoglan I, Cagatay A, Celen MK, Koruk ST, Ceylan B, Yildirmak T, Akalın H, Korten V, Willke A. HIV-1 Transmitted Drug Resistance Mutations in Newly Diagnosed Antiretroviral-Naive Patients in Turkey. AIDS Res Hum Retroviruses 2016; 32:26-31. [PMID: 26414663 PMCID: PMC4692107 DOI: 10.1089/aid.2015.0110] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
HIV-1 replication is rapid and highly error-prone. Transmission of a drug-resistant HIV-1 strain is possible and occurs within the HIV-1-infected population. In this study, we aimed to determine the prevalence of transmitted drug resistance mutations (TDRMs) in 1,306 newly diagnosed untreated HIV-1-infected patients from 21 cities across six regions of Turkey between 2010 and 2015. TDRMs were identified according to the criteria provided by the World Health Organization's 2009 list of surveillance drug resistance mutations. The HIV-1 TDRM prevalence was 10.1% (133/1,306) in Turkey. Primary drug resistance mutations (K65R, M184V) and thymidine analogue-associated mutations (TAMs) were evaluated together as nucleos(t)ide reverse transcriptase inhibitor (NRTI) mutations. NRTI TDRMs were found in 8.1% (107/1,306) of patients. However, TAMs were divided into three categories and M41L, L210W, and T215Y mutations were found for TAM1 in 97 (7.4%) patients, D67N, K70R, K219E/Q/N/R, T215F, and T215C/D/S mutations were detected for TAM2 in 52 (3.9%) patients, and M41L + K219N and M41L + T215C/D/S mutations were detected for the TAM1 + TAM2 profile in 22 (1.7%) patients, respectively. Nonnucleoside reverse transcriptase inhibitor-associated TDRMs were detected in 3.3% (44/1,306) of patients (L100I, K101E/P, K103N/S, V179F, Y188H/L/M, Y181I/C, and G190A/E/S) and TDRMs to protease inhibitors were detected in 2.3% (30/1,306) of patients (M46L, I50V, I54V, Q58E, L76V, V82A/C/L/T, N83D, I84V, and L90M). In conclusion, long-term and large-scale monitoring of regional levels of HIV-1 TDRMs informs treatment guidelines and provides feedback on the success of HIV-1 prevention and treatment efforts.
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Affiliation(s)
- Murat Sayan
- Faculty of Medicine, Clinical Laboratory, PCR Unit, University of Kocaeli, Kocaeli, Turkey
- Research Center of Experimental Health Sciences, University of Near East, Nicosia, Northern Cyprus
| | - Fatma Sargin
- Goztepe Educational and Research Hospital, Clinic of Infectious Diseases, Medeniyet University, Istanbul, Turkey
| | - Dilara Inan
- Faculty of Medicine, Department of Infectious Diseases, University of Akdeniz, Antalya, Turkey
| | - Dilek Y. Sevgi
- Educational and Research Hospital, Clinic of Infectious Diseases, Sisli Etfal, Istanbul, Turkey
| | - Aysel K. Celikbas
- Educational and Research Hospital, Clinic of Infectious Diseases, Ankara Numune, Ankara, Turkey
| | - Kadriye Yasar
- Educational and Research Hospital, Clinic of Infectious Diseases, Bakırkoy Dr. Sadi Konuk, Istanbul,Turkey
| | - Figen Kaptan
- Educational and Research Hospital, Department of Infectious Diseases, University of Katip Celebi, İzmir, Turkey
| | - Selda Kutlu
- Faculty of Medicine, Department of Infectious Diseases, University of Pamukkale, Denizli, Turkey
| | - Nuriye T. Fisgin
- Faculty of Medicine, Department of Infectious Diseases, University of 19 Mayıs, Samsun, Turkey
| | - Ayse Inci
- Educational and Research Hospital, Clinic of Infectious Diseases, Istanbul Kanuni Sultan Süleyman, Istanbul, Turkey
| | - Nurgul Ceran
- Educational and Research Hospital, Clinic of Infectious Diseases, Haydarpasa Numune, Istanbul, Turkey
| | - Ilkay Karaoglan
- Faculty of Medicine, Department of Infectious Diseases, University of Gaziantep, Gaziantep, Turkey
| | - Atahan Cagatay
- Faculty of Medicine, Department of Infectious Diseases, University of Istanbul, Istanbul, Turkey
| | - Mustafa K. Celen
- Faculty of Medicine, Department of Infectious Diseases, University of Dicle, Diyarbakır, Turkey
| | - Suda T. Koruk
- Faculty of Medicine, Department of Infectious Diseases, University of Harran, Urfa, Turkey
| | - Bahadir Ceylan
- Faculty of Medicine, Department of Infectious Diseases, University of Bezm-i Alem, Istanbul, Turkey
| | - Taner Yildirmak
- Educational and Research Hospital, Clinic of Infectious Diseases, Istanbul Okmeydani, Istanbul, Turkey
| | - Halis Akalın
- Faculty of Medicine, Department of Infectious Diseases, University of Uludag, Bursa, Turkey
| | - Volkan Korten
- Faculty of Medicine, Department of Infectious Diseases, University of Marmara, Istanbul, Turkey
| | - Ayse Willke
- Faculty of Medicine, Department of Infectious Diseases, University of Kocaeli, Kocaeli, Turkey
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5
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Increase in transmitted resistance to non-nucleoside reverse transcriptase inhibitors among newly diagnosed HIV-1 infections in Europe. BMC Infect Dis 2014; 14:407. [PMID: 25047543 PMCID: PMC4223652 DOI: 10.1186/1471-2334-14-407] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2013] [Accepted: 07/01/2014] [Indexed: 01/24/2023] Open
Abstract
Background One out of ten newly diagnosed patients in Europe was infected with a virus carrying a drug resistant mutation. We analysed the patterns over time for transmitted drug resistance mutations (TDRM) using data from the European Spread program. Methods Clinical, epidemiological and virological data from 4317 patients newly diagnosed with HIV-1 infection between 2002 and 2007 were analysed. Patients were enrolled using a pre-defined sampling strategy. Results The overall prevalence of TDRM in this period was 8.9% (95% CI: 8.1-9.8). Interestingly, significant changes over time in TDRM caused by the different drug classes were found. Whereas nucleoside resistance mutations remained constant at 5%, a significant decline in protease inhibitors resistance mutations was observed, from 3.9% in 2002 to 1.6% in 2007 (p = 0.001). In contrast, resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) doubled from 2.0% in 2002 to 4.1% in 2007 (p = 0.004) with 58% of viral strains carrying a K103N mutation. Phylogenetic analysis showed that these temporal changes could not be explained by large clusters of TDRM. Conclusion During the years 2002 to 2007 transmitted resistance to NNRTI has doubled to 4% in Europe. The frequent use of NNRTI in first-line regimens and the clinical impact of NNRTI mutations warrants continued monitoring.
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6
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Parczewski M, Urbanska A, Grzeszczuk A, Maciejewska K, Witak-Jedra M, Leszczyszyn-Pynka M. Phylogeographic analysis on the travel-related introduction of HIV-1 non-B subtypes to Northern Poland. INFECTION GENETICS AND EVOLUTION 2014; 27:121-30. [PMID: 25038296 DOI: 10.1016/j.meegid.2014.07.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 06/27/2014] [Accepted: 07/05/2014] [Indexed: 11/16/2022]
Abstract
Phylodynamic, sequence data based reconstructions for the surveillance of the geographic spatial spread are a powerful tool in molecular epidemiology. In this study region of origin for the set of 57 partial pol sequences derived from the patients the history of travel-related HIV transmission was analyzed using phylogeographic approach. Maximum likelihood trees based on the sets of country-annotated reference sequences were inferred for identified non-B variants. Region of sequence import was assigned using on the highest approximate likelihood ratios. Import of the A1 clades was traced to the Eastern Europe and associated with immigration from this region. Subtype C infections clustered most frequently with sequences of the South African origin while majority of subtype Ds were similar to the European clades. Subtype G sequences clustered with Portuguese lineage, CRF01_AE with Eastern or South-Eastern Asian. Eastern European, Middle African or Western African lineage was assigned for the CFR02_AG. Rare circulating recombinants originated either from Central Africa (CRF11_cpx - Democratic Republic of Congo, CRF13_cpx - Central African Republic, CRF37_cpx - Cameroon) or South America (CRF28_BF and CRF46_BF - Brazil). Import of the HIV-1 non-B variants, including recombinant forms previously rarely found in Poland and Europe is frequent among travelers. Observed founder events result in the heterosexually-driven introduction of the novel HIV-1 variants into the population.
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Affiliation(s)
- Milosz Parczewski
- Department of Infectious Diseases and Hepatology, Pomeranian Medical University, Szczecin, Poland.
| | - Anna Urbanska
- Department of Infectious Diseases and Hepatology, Pomeranian Medical University, Szczecin, Poland
| | - Anna Grzeszczuk
- Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Bialystok, Poland
| | - Katarzyna Maciejewska
- Department of Infectious Diseases and Hepatology, Pomeranian Medical University, Szczecin, Poland
| | - Magdalena Witak-Jedra
- Department of Infectious Diseases and Hepatology, Pomeranian Medical University, Szczecin, Poland
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7
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Pineda-Peña AC, Schrooten Y, Vinken L, Ferreira F, Li G, Trovão NS, Khouri R, Derdelinckx I, De Munter P, Kücherer C, Kostrikis LG, Nielsen C, Littsola K, Wensing A, Stanojevic M, Paredes R, Balotta C, Albert J, Boucher C, Gomez-Lopez A, Van Wijngaerden E, Van Ranst M, Vercauteren J, Vandamme AM, Van Laethem K. Trends and predictors of transmitted drug resistance (TDR) and clusters with TDR in a local Belgian HIV-1 epidemic. PLoS One 2014; 9:e101738. [PMID: 25003369 PMCID: PMC4086934 DOI: 10.1371/journal.pone.0101738] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2014] [Accepted: 06/10/2014] [Indexed: 11/23/2022] Open
Abstract
We aimed to study epidemic trends and predictors for transmitted drug resistance (TDR) in our region, its clinical impact and its association with transmission clusters. We included 778 patients from the AIDS Reference Center in Leuven (Belgium) diagnosed from 1998 to 2012. Resistance testing was performed using population-based sequencing and TDR was estimated using the WHO-2009 surveillance list. Phylogenetic analysis was performed using maximum likelihood and Bayesian techniques. The cohort was predominantly Belgian (58.4%), men who have sex with men (MSM) (42.8%), and chronically infected (86.5%). The overall TDR prevalence was 9.6% (95% confidence interval (CI): 7.7-11.9), 6.5% (CI: 5.0-8.5) for nucleoside reverse transcriptase inhibitors (NRTI), 2.2% (CI: 1.4-3.5) for non-NRTI (NNRTI), and 2.2% (CI: 1.4-3.5) for protease inhibitors. A significant parabolic trend of NNRTI-TDR was found (p = 0.019). Factors significantly associated with TDR in univariate analysis were male gender, Belgian origin, MSM, recent infection, transmission clusters and subtype B, while multivariate and Bayesian network analysis singled out subtype B as the most predictive factor of TDR. Subtype B was related with transmission clusters with TDR that included 42.6% of the TDR patients. Thanks to resistance testing, 83% of the patients with TDR who started therapy had undetectable viral load whereas half of the patients would likely have received a suboptimal therapy without this test. In conclusion, TDR remained stable and a NNRTI up-and-down trend was observed. While the presence of clusters with TDR is worrying, we could not identify an independent, non-sequence based predictor for TDR or transmission clusters with TDR that could help with guidelines or public health measures.
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Affiliation(s)
- Andrea-Clemencia Pineda-Peña
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Clinical and Molecular Infectious Diseases Group, Faculty of Sciences and Mathematics, Universidad del Rosario, Bogotá, Colombia
| | - Yoeri Schrooten
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Lore Vinken
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Fossie Ferreira
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Guangdi Li
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Nídia Sequeira Trovão
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Ricardo Khouri
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Inge Derdelinckx
- Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Paul De Munter
- Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | | | | | | | - Kirsi Littsola
- National Institute of health and welfare, Helsinki, Finland
| | - Annemarie Wensing
- Department of Virology, University Medical Center Utrecht, The Netherlands
| | - Maja Stanojevic
- University of Belgrade, Faculty of Medicine, Belgrade, Serbia
| | | | | | - Jan Albert
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
- Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden
| | - Charles Boucher
- Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Arley Gomez-Lopez
- Clinical and Molecular Infectious Diseases Group, Faculty of Sciences and Mathematics, Universidad del Rosario, Bogotá, Colombia
| | - Eric Van Wijngaerden
- Clinical Infectious and Inflammatory Disorders, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Internal Medicine, University Hospitals Leuven, Leuven, Belgium
| | - Marc Van Ranst
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
| | - Jurgen Vercauteren
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
| | - Anne-Mieke Vandamme
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- Centro de Malária e outras Doenças Tropicais and Unidade de Microbiologia, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal
| | - Kristel Van Laethem
- Clinical and Epidemiological Virology, Rega Institute for Medical Research, Department of Microbiology and Immunology, KU Leuven, Leuven, Belgium
- AIDS Reference Laboratory, University Hospitals Leuven, Leuven, Belgium
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First line treatment response in patients with transmitted HIV drug resistance and well defined time point of HIV infection: updated results from the German HIV-1 seroconverter study. PLoS One 2014; 9:e95956. [PMID: 24788613 PMCID: PMC4006817 DOI: 10.1371/journal.pone.0095956] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2013] [Accepted: 04/02/2014] [Indexed: 12/19/2022] Open
Abstract
Background Transmission of drug-resistant HIV-1 (TDR) can impair the virologic response to antiretroviral combination therapy. Aim of the study was to assess the impact of TDR on treatment success of resistance test-guided first-line therapy in the German HIV-1 Seroconverter Cohort for patients infected with HIV between 1996 and 2010. An update of the prevalence of TDR and trend over time was performed. Methods Data of 1,667 HIV-infected individuals who seroconverted between 1996 and 2010 were analysed. The WHO drug resistance mutations list was used to identify resistance-associated HIV mutations in drug-naïve patients for epidemiological analysis. For treatment success analysis the Stanford algorithm was used to classify a subset of 323 drug-naïve genotyped patients who received a first-line cART into three resistance groups: patients without TDR, patients with TDR and fully active cART and patients with TDR and non-fully active cART. The frequency of virologic failure 5 to 12 months after treatment initiation was determined. Results Prevalence of TDR was stable at a high mean level of 11.9% (198/1,667) in the HIV-1 Seroconverter Cohort without significant trend over time. Nucleotide reverse transcriptase inhibitor resistance was predominant (6.0%) and decreased significantly over time (OR = 0.92, CI = 0.87–0.98, p = 0.01). Non-nucleoside reverse transcriptase inhibitor (2.4%; OR = 1.00, CI = 0.92–1.09, p = 0.96) and protease inhibitor resistance (2.0%; OR = 0.94, CI = 0.861.03, p = 0.17) remained stable. Virologic failure was observed in 6.5% of patients with TDR receiving fully active cART, 5,6% of patients with TDR receiving non-fully active cART and 3.2% of patients without TDR. The difference between the three groups was not significant (p = 0.41). Conclusion Overall prevalence of TDR remained stable at a rather high level. No significant differences in the frequency of virologic failure were identified during first-line cART between patients with TDR and fully-active cART, patients with TDR and non-fully active cART and patients without TDR.
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Antoniadou ZA, Hezka J, Kousiappa I, Mamais I, Skoura L, Pilalas D, Metallidis S, Nicolaidis P, Malisiovas N, Kostrikis LG. Cellular HIV type 1 DNA levels are equivalent among drug-sensitive and drug-resistant strains in newly diagnosed and antiretroviral naive patients. AIDS Res Hum Retroviruses 2014; 30:266-71. [PMID: 24025041 DOI: 10.1089/aid.2013.0160] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The emergence of resistance against current antiretroviral drugs to human immunodeficiency virus type 1 (HIV-1) is an increasingly important concern to the continuous success of antiretroviral therapy to HIV-1-infected patients. In the past decade, a number of studies reported that the prevalence of transmitted drug resistance among newly diagnosed patients has reached an overall 9% prevalence worldwide. Also, a number of studies using longitudinal HIV-1 patient study cohorts demonstrated that the cellular HIV-1 DNA level in peripheral blood mononuclear cells (PBMCs) has a prognostic value for the progression of HIV-1 disease independently of plasma HIV-1 RNA load and CD4 count. Using a previously established molecular-beacon-based real-time PCR methodology, cellular HIV-1 DNA levels were quantified in newly diagnosed and antiretroviral-naive patients in Northern Greece recruited between 2009 and 2010 using a predefined enrolling strategy, in an effort to investigate whether there is any relationship between cellular HIV-1 DNA levels and HIV-1 transmitted drug resistance. As part of the same study, DNA sequences encoding the env (C2-C5 region of gp120) were also amplified from PBMC-extracted DNA in order to determine the genotypic coreceptor tropism and genetic subtype. Cellular HIV-1 DNA levels had a median of 3.309 log10 HIV-1 copies per 10(6) PBMCs and demonstrated no correlation between cellular HIV-1 DNA levels and HIV-1 transmitted drug resistance. An absence of association between cellular HIV-1 DNA levels with plasma viral HIV-1 RNA load and CD4 levels was also found reconfirming the previously published study. Genotypic analysis of coreceptor tropism indicated that 96% of samples, independently of the presence or not of genotypic drug resistance, were CCR5-tropic. Overall, the findings reconfirmed the previously proposed proposition that transmitted drug resistance does not have an impact on disease progression in HIV-1-infected individuals. Also, CCR5 coreceptor tropism dominance suggests that both drug-resistant and drug-sensitive strains behave similarly in early infection in newly diagnosed patients.
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Affiliation(s)
- Zoi-Anna Antoniadou
- 1 AIDS National Reference Laboratory of Northern Greece, Department of Microbiology, School of Medicine, Aristotle University of Thessaloniki , Thessaloniki, Greece
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Abstract
A total of 1055 nucleotide sequences obtained from HIV patients diagnosed in 2008 and 2009 in Belgium were included in this prevalence study. The study population is a group of patients whose visit was considered by the clinician as the first contact with a Belgian AIDS reference centre or with another clinical centre experienced in HIV care. Prevalences of surveillance drug resistance mutations (SDRM) of 11·7% (47/394) and 11·0% (73/661) were observed in 2008 and 2009, respectively. The highest level of SDRM was observed towards nucleoside reverse transcriptase inhibitors (NRTIs) (7·8%), followed by the non-nucleoside reverse transcriptase inhibitors (NNRTIs) (4·2%) and Protease inhibitors (PIs) (2·3%). A potential clinical impact of the SDRM was demonstrated when using the current first-line therapy. A particularly high prevalence of SDRM was observed among intravenous drug users (IDUs) (29·4%). Reanalysis and comparing the data from previous Belgian studies using similar interpretation algorithms could not reveal a significant trend in SDRM prevalence over the last 5 years.
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Pilotto JH, Grinsztejn B, Veloso VG, Velasque LS, Friedman RK, Moreira RI, Rodrigues-Pedro A, Oliveira SM, Currier JS, Morgado MG. Moderate prevalence of transmitted drug resistance mutations among antiretroviral-naive HIV-infected pregnant women in Rio de Janeiro, Brazil. AIDS Res Hum Retroviruses 2013; 29:681-6. [PMID: 23259924 DOI: 10.1089/aid.2011.0333] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Transmission of drug-resistant HIV-1 strains has been gaining attention and is becoming a growing problem throughout the world. The aim of this study was to determine the prevalence of transmitted drug resistance mutations (TDRM) among antiretroviral (ARV)-naive HIV-infected pregnant women in Rio de Janeiro, Brazil. ARV-naive pregnant women were recruited at Hospital Geral de Nova Iguacu (HGNI), Rio de Janeiro, from 2005 to 2008. HIV genotyping was carried out using ViroSeq (Abbott v. 2.0). TDRM were detected using the Calibrated Population Resistance Tool-CPR v. 6.0.The prevalence of mutations associated with resistance in the protease and reverse transcriptase regions of the HIV genome were assessed in samples collected prior to initiation of ARV prophylaxis or treatment. Among 238 eligible specimens that were collected, 197 samples were successfully amplified using reverse transcription polymerase chain reaction. Eighty-one percent of women were infected with HIV subtype B, 10% with subtype F1 viruses, 1.0% with subtype C virus, and 8.0% with recombinant forms of the virus. The prevalence of HIV TDRM was 5.6% for nucleoside reverse transcriptase inhibitors, 2.0% for nonnucleoside reverse transcriptase inhibitors, and 3.0% for protease inhibitors. The overall prevalence of any drug resistance was 10.7%. There were no multiclass resistant strains identified in the analyzed samples. The prevalence of HIV TDRM among the pregnant women in our cohort was moderate. Resistance testing should be encouraged in Rio de Janeiro, among other locations, for all HIV-infected pregnant women prior to prevention of mother-to-child transmission of HIV.
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Affiliation(s)
- José H. Pilotto
- Instituto Oswaldo Cruz/FIOCRUZ, AIDS and Molecular Immunology Laboratory, Rio de Janeiro, Brazil
- Hospital Geral de Nova Iguaçu (HGNI), HIV Family Care Clinic (HHFCC), Rio de Janeiro, Brazil
| | - Beatriz Grinsztejn
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, Brazil
| | - Valdilea G. Veloso
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, Brazil
| | - Luciane S. Velasque
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, Brazil
- Department of Mathematics and Statistics, Universidade Federal do Estado do Rio de Janeiro (UNIRIO), Rio de Janeiro, Brazil
| | - Ruth K. Friedman
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, Brazil
| | - Ronaldo I. Moreira
- Fundação Oswaldo Cruz, Instituto de Pesquisa Clínica Evandro Chagas/IPEC, Rio de Janeiro, Brazil
| | - Adriana Rodrigues-Pedro
- Instituto Oswaldo Cruz/FIOCRUZ, AIDS and Molecular Immunology Laboratory, Rio de Janeiro, Brazil
| | - Sandra M. Oliveira
- Hospital Geral de Nova Iguaçu (HGNI), HIV Family Care Clinic (HHFCC), Rio de Janeiro, Brazil
| | - Judith S. Currier
- David Geffen School of Medicine at UCLA, Division of Infectious Diseases and Center for Clinical AIDS Research and Education, University of California, Los Angeles, California
| | - Mariza G. Morgado
- Instituto Oswaldo Cruz/FIOCRUZ, AIDS and Molecular Immunology Laboratory, Rio de Janeiro, Brazil
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Machado LY, Dubed M, Díaz H, Ruiz N, Romay D, Váldes N, Blanco M, Silva E. Transmitted HIV type 1 drug resistance in newly diagnosed Cuban patients. AIDS Res Hum Retroviruses 2013; 29:411-4. [PMID: 22985307 DOI: 10.1089/aid.2012.0183] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Knowledge of the associated mutations to transmitted drug resistance (TDR) in strains of human immunodeficiency virus type 1 (HIV-1) constitutes a fundamental premise in epidemiological surveillance. In this present study, TDR from 200 Cuban patients who were diagnosed with HIV-1 between 2009 and 2011 was analyzed. By partial reverse transcriptase polymerase chain reaction (RT-PCR) and sequencing of the HIV pol gene, an HIV subtype and transmitted resistance profile were determined. The prevalence of associated mutations to the TDR in the individuals studied was 21.5%. In the region of the reverse transcriptase, the most common mutations were K103N and M184V, while in the region of the protease they were L33F and M46L. The results of this study provide evidence of TDR in the Cuban seropositive population and suggest the necessity of making resistance assays before beginning antiretroviral therapy in HIV-1-infected patients in Cuba.
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Affiliation(s)
- Liuber Y. Machado
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
| | - Marta Dubed
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
| | - Héctor Díaz
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
| | - Nancy Ruiz
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
| | - Dania Romay
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
| | - Neysi Váldes
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
| | - Madeline Blanco
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
| | - Eladio Silva
- AIDS Research Laboratory, Carretera Tapaste y Autopista Nacional, San José de las Lajas, Mayabeque, Cuba
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Grgic I, Lepej SZ, Lunar MM, Poljak M, Vince A, Vrakela IB, Planinic A, Seme K, Begovac J. The prevalence of transmitted drug resistance in newly diagnosed HIV-infected individuals in Croatia: the role of transmission clusters of men who have sex with men carrying the T215S surveillance drug resistance mutation. AIDS Res Hum Retroviruses 2013; 29:329-36. [PMID: 22906365 PMCID: PMC3552172 DOI: 10.1089/aid.2012.0191] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The aim of this study was to determine the prevalence of transmitted drug resistance (TDR) in newly diagnosed and treatment-naive HIV-infected patients from Croatia and evaluate a possible contribution of transmission clusters to the spread of resistant virus. The study enrolled treatment-naive HIV-infected patients that entered clinical care at the Croatian Reference Center for HIV/AIDS between 2006 and 2008. The protease gene and a part of the reverse transcriptase gene of the HIV-1 genome were sequenced by using the Trugene HIV-1 Genotyping System. The prevalence of transmitted drug resistance was analyzed by using the surveillance drug resistance mutations (SDRM) list recommended by the WHO in 2009. We report findings for 118 of 180 eligible patients (65.6% coverage). SDRM were detected in 26 of 118 patients (22.0%) who were infected with subtype B and belonged mostly to the men having sex with men (MSM). The majority of patients with primary resistance carried SDRM associated with resistance to nucleoside analogues reverse transcriptase inhibitors (NRTIs, 23 of 118 patients, 19.5%). The most frequently found NRTI SDRM was T215S (17 of 118 patients, 14.4%). SDRM associated with resistance to nonnucleoside reverse transcriptase inhibitors were detected in three (2.5%) patients and primary resistance to protease inhibitors was not detected. Non-B subtypes were detected in 13/118 patients (11%). A total of 12 transmission pairs and eight distinct transmission clusters were identified with the largest cluster harboring sequences from 19 patients; among them all but two were carrying the T215S mutation. This study showed a high prevalence of TDR in newly diagnosed MSM from Croatia and is an important contribution concerning the relationship between local transmission clusters and the spread of resistant virus.
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Affiliation(s)
- Ivana Grgic
- Department of Flow Cytometry and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic,” Zagreb, Croatia
| | - Snjezana Zidovec Lepej
- Department of Flow Cytometry and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic,” Zagreb, Croatia
| | - Maja M. Lunar
- Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Adriana Vince
- Department of HIV/AIDS, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic” and University of Zagreb School of Medicine, Zagreb, Croatia
| | - Ivana Baca Vrakela
- Department of Flow Cytometry and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic,” Zagreb, Croatia
| | - Ana Planinic
- Department of Flow Cytometry and Molecular Diagnostics, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic,” Zagreb, Croatia
| | - Katja Seme
- Institute of Microbiology and Immunology, University of Ljubljana, Ljubljana, Slovenia
| | - Josip Begovac
- Department of HIV/AIDS, University Hospital for Infectious Diseases “Dr. Fran Mihaljevic” and University of Zagreb School of Medicine, Zagreb, Croatia
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Thao VP, Le T, Török EM, Yen NTB, Chau TTH, Jurriaans S, van Doorn HR, de Jong MD, Farrar JJ, Dunstan SJ. Hiv-1 Drug Resistance in Antiretroviral-Naive Individuals with HIV-1-Associated Tuberculous Meningitis Initiating Antiretroviral Therapy in Vietnam. Antivir Ther 2012. [DOI: 10.3851/imp2098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Affiliation(s)
- Vu P Thao
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
| | - Thuy Le
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hawaii Center for AIDS, University of Hawaii at Manoa, Honolulu, HI, USA
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Estee M Török
- University of Cambridge, Department of Medicine, Addenbrooke's Hospital, Cambridge, UK
| | - Nguyen TB Yen
- Pham Ngoc Thach Hospital for Tuberculosis and Lung Disease, Ho Chi Minh City, Vietnam
| | - Tran TH Chau
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Hospital for Tropical Diseases, Ho Chi Minh City, Vietnam
| | - Suzanne Jurriaans
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - H Rogier van Doorn
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Menno D de Jong
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Department of Medical Microbiology, Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands
| | - Jeremy J Farrar
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
| | - Sarah J Dunstan
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
- Centre for Tropical Medicine, Nuffield Department of Clinical Medicine, Oxford University, Oxford, UK
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15
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Thao VP, Le T, Török EM, Yen NTB, Chau TTH, Jurriaans S, van Doorn HR, van Doorn RH, de Jong MD, Farrar JJ, Dunstan SJ. HIV-1 drug resistance in antiretroviral-naive individuals with HIV-1-associated tuberculous meningitis initiating antiretroviral therapy in Vietnam. Antivir Ther 2012; 17:905-13. [PMID: 22473024 DOI: 10.3851/imp2092] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/10/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Access to antiretroviral therapy (ART) for HIV-infected individuals in Vietnam is rapidly expanding, but there are limited data on HIV drug resistance (HIVDR) to guide ART strategies. METHODS We retrospectively conducted HIVDR testing in 220 ART-naive individuals recruited to a randomized controlled trial of immediate versus deferred ART in individuals with HIV-associated tuberculous meningitis in Ho Chi Minh City (HCMC) from 2005-2008. HIVDR mutations were identified by population sequencing of the HIV pol gene and were defined based on 2009 WHO surveillance drug resistance mutations (SDRMs). RESULTS We successfully sequenced 219/220 plasma samples of subjects prior to ART; 218 were subtype CRF01_AE and 1 was subtype B. SDRMs were identified in 14/219 (6.4%) subjects; 8/14 were resistant to nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs; T69D, L74V, V75M, M184V/I and K219R), 5/14 to non-nucleoside reverse transcriptase inhibitors (NNRTIs; K103N, V106M, Y181C, Y188C and G190A), 1/14 to both NRTIs and NNRTIs (D67N and Y181C) and none to protease inhibitors. After 6 months of ART, eight subjects developed protocol-defined virological failure. HIVDR mutations were identified in 5/8 subjects. All five had mutations with high-level resistance to NNRTIs and three had mutations with high-level resistance to NRTIs. Due to a high early mortality rate (58%), the effect of pre-existing HIVDR mutations on treatment outcome could not be accurately assessed. CONCLUSIONS The prevalence of WHO SDRMs in ART-naive individuals with HIV-associated tuberculous meningitis in HCMC from 2005-2008 is 6.4%. The SDRMs identified conferred resistance to NRTIs and/or NNRTIs, reflecting the standard first-line ART regimens in Vietnam.
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Affiliation(s)
- Vu P Thao
- Wellcome Trust Major Overseas Programme, Oxford University Clinical Research Unit, Ho Chi Minh City, Vietnam
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Oette M, Reuter S, Kaiser R, Lengauer T, Fätkenheuer G, Knechten H, Hower M, Pfister H, Häussinger D. Epidemiology of transmitted drug resistance in chronically HIV-infected patients in Germany: the RESINA study 2001-2009. Intervirology 2012; 55:154-9. [PMID: 22286886 DOI: 10.1159/000332015] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVES Transmitted HIV drug resistance may impair treatment efficacy of combination antiretroviral therapy (ART). This study describes the epidemiology of transmitted resistance in chronically infected patients. METHODS In a prospective multicenter trial in Nordrhein-Westfalen, Germany, transmitted drug resistance was determined by genotypic resistance testing in patients on initiation of first-line ART. RESULTS From 2001 to 2009, 2,078 patients were enrolled in the study. 79.9% were male, 81.2% were Caucasians, and a homosexual transmission mode was found in 51.3%. Of these patients, 41.5% were at the stage of AIDS, median CD4 cell count was 230/μl, and median viral load was 64.466 copies/ml. Transmitted drug resistance mutations were seen in 9.2% (95% CI, 7.9-10.4). Resistance in the nucleoside reverse transcriptase inhibitor class was found in 5.8% (4.8-6.8), in the nonnucleoside reverse transcriptase inhibitor class in 2.8% (2.1-3.6), and in the protease inhibitor class in 2.7% (2.0-3.4). After a continuous increase to a level above 10% in the years 2006 and 2007, a decline of drug resistance prevalence followed in 2008 and 2009. CONCLUSIONS Transmitted HIV drug resistance was found in around 10% of chronically infected patients in Germany who started their ART. We showed a moderate decline of the prevalence of mutant virus strains in recent years. Further surveillance of this phenomenon is mandatory.
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Affiliation(s)
- Mark Oette
- Clinic for General Medicine, Gastroenterology and Infectious Diseases, Augustinerinnen Hospital, Cologne, Germany.
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Hattori J, Shiino T, Gatanaga H, Yoshida S, Watanabe D, Minami R, Sadamasu K, Kondo M, Mori H, Ueda M, Tateyama M, Ueda A, Kato S, Ito T, Oie M, Takata N, Hayashida T, Nagashima M, Matsuda M, Ibe S, Ota Y, Sasaki S, Ishigatsubo Y, Tanabe Y, Koga I, Kojima Y, Yamamoto M, Fujita J, Yokomaku Y, Koike T, Shirasaka T, Oka S, Sugiura W. Trends in transmitted drug-resistant HIV-1 and demographic characteristics of newly diagnosed patients: Nationwide surveillance from 2003 to 2008 in Japan. Antiviral Res 2010; 88:72-9. [DOI: 10.1016/j.antiviral.2010.07.008] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2010] [Revised: 07/12/2010] [Accepted: 07/28/2010] [Indexed: 10/19/2022]
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Chalmet K, Staelens D, Blot S, Dinakis S, Pelgrom J, Plum J, Vogelaers D, Vandekerckhove L, Verhofstede C. Epidemiological study of phylogenetic transmission clusters in a local HIV-1 epidemic reveals distinct differences between subtype B and non-B infections. BMC Infect Dis 2010; 10:262. [PMID: 20822507 PMCID: PMC2940905 DOI: 10.1186/1471-2334-10-262] [Citation(s) in RCA: 82] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2010] [Accepted: 09/07/2010] [Indexed: 11/20/2022] Open
Abstract
Background The number of HIV-1 infected individuals in the Western world continues to rise. More in-depth understanding of regional HIV-1 epidemics is necessary for the optimal design and adequate use of future prevention strategies. The use of a combination of phylogenetic analysis of HIV sequences, with data on patients' demographics, infection route, clinical information and laboratory results, will allow a better characterization of individuals responsible for local transmission. Methods Baseline HIV-1 pol sequences, obtained through routine drug-resistance testing, from 506 patients, newly diagnosed between 2001 and 2009, were used to construct phylogenetic trees and identify transmission-clusters. Patients' demographics, laboratory and clinical data, were retrieved anonymously. Statistical analysis was performed to identify subtype-specific and transmission-cluster-specific characteristics. Results Multivariate analysis showed significant differences between the 59.7% of individuals with subtype B infection and the 40.3% non-B infected individuals, with regard to route of transmission, origin, infection with Chlamydia (p = 0.01) and infection with Hepatitis C virus (p = 0.017). More and larger transmission-clusters were identified among the subtype B infections (p < 0.001). Overall, in multivariate analysis, clustering was significantly associated with Caucasian origin, infection through homosexual contact and younger age (all p < 0.001). Bivariate analysis additionally showed a correlation between clustering and syphilis (p < 0.001), higher CD4 counts (p = 0.002), Chlamydia infection (p = 0.013) and primary HIV (p = 0.017). Conclusions Combination of phylogenetics with demographic information, laboratory and clinical data, revealed that HIV-1 subtype B infected Caucasian men-who-have-sex-with-men with high prevalence of sexually transmitted diseases, account for the majority of local HIV-transmissions. This finding elucidates observed epidemiological trends through molecular analysis, and justifies sustained focus in prevention on this high risk group.
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Kabamba-Mukadi B, Duquenne A, Henrivaux P, Musuamba F, Ruelle J, Yombi JC, Bodéus M, Vandercam B, Goubau P. HIV-1 proviral resistance mutations: usefulness in clinical practice. HIV Med 2010; 11:483-92. [PMID: 20163482 DOI: 10.1111/j.1468-1293.2009.00814.x] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES Transmitted HIV strains may harbour drug resistance mutations. HIV-1 drug resistance mutations are currently detected in plasma viral RNA. HIV-1 proviral DNA could be an alternative marker, as it persists in infected cells. METHODS This was a prospective study assessing the prevalence and persistence of HIV-1 drug resistance mutations in DNA from CD4 cells before and after protease inhibitor (PI)- or nonnucleoside reverse transcriptase inhibitor (NNRTI)-based therapy initiation in 69 drug-naïve patients. RESULTS Before therapy, 90 and 66% of detected mutations were present in CD4 cells and plasma, respectively. We detected seven key mutations, and four of these (M184M/V, M184M/I, K103K/N and M46M/I) were only found in the cells. When treatment was started, 40 patients were followed; the mutations detected at the naïve stage remained present for at least 1 year. Under successful treatment, new key mutations emerged in CD4 cells (M184I, M184M/I and Y188Y/H). CONCLUSIONS The proportion of mutations detected in the DNA was statistically significantly higher than that detected in standard RNA genotyping, and these mutations persisted for at least 1 year irrespective of therapy. The pre-existence of resistance mutations did not jeopardise treatment outcome when the drug concerned was not included in the regimen. Analysis of HIV-1 DNA could be useful in chronic infections or when switching therapy in patients with undetectable viraemia.
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Affiliation(s)
- B Kabamba-Mukadi
- Université Catholique de Louvain, AIDS Reference Laboratory, Brussels, Belgium.
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Low-frequency K103N strengthens the impact of transmitted drug resistance on virologic responses to first-line efavirenz or nevirapine-based highly active antiretroviral therapy. J Acquir Immune Defic Syndr 2009; 52:569-73. [PMID: 19779307 DOI: 10.1097/qai.0b013e3181ba11e8] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND There are conflicting data on the impact of low-frequency transmitted drug-resistant mutants on responses to first-line highly active antiretroviral therapy (HAART). METHODS Patients started nevirapine or efavirenz with two or more nucleoside/nucleotide reverse transcriptase inhibitors in 1998-2007 without a prior resistance test at a median 1.0 (interquartile range, 0.0-3.4) year after diagnosis and with a median 218 (interquartile range, 131-296) CD4 cells/mm3, and had at least 24 weeks of follow up. Pre-HAART plasma samples were tested retrospectively by bulk genotyping and sensitive real-time polymerase chain reaction targeting reverse transcriptase K65R, K103N, Y181C, M184V, and G190A (interpretative cutoff 0.3%-0.9%). RESULTS Among 93 patients, seven of 18 who experienced virologic failure and zero of 75 who maintained virologic suppression showed pre-HAART resistance, including three with high-frequency mutations detectable by bulk genotyping (two K103N, one G190A) and four with low-frequency K103N detectable only by polymerase chain reaction. Detection of either bulk (P = 0.006) or low-frequency (P = 0.001) resistance was significantly associated with the odds of virologic failure; combining the two markedly increased the strength of the association (P < 0.0001). At failure, the pre-HAART mutations were detected by bulk genotyping in five of seven patients alongside additional reverse transcriptase mutations. CONCLUSIONS Low-frequency K103N mutants were as prevalent as bulk-detectable variants before starting HAART. Both high- and low-frequency mutants were significantly associated with virologic failure.
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Lihana RW, Khamadi SA, Lubano K, Lwembe R, Kiptoo MK, Lagat N, Kinyua JG, Okoth FA, Songok EM, Makokha EP, Ichimura H. HIV type 1 subtype diversity and drug resistance among HIV type 1-infected Kenyan patients initiating antiretroviral therapy. AIDS Res Hum Retroviruses 2009; 25:1211-7. [PMID: 19954302 DOI: 10.1089/aid.2009.0007] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The treatment of HIV-1 infection with antiretroviral drugs has greatly improved the survival of those who are infected. However, HIV-1 diversity and drug resistance are major challenges in patient management, especially in resource-poor countries. To evaluate HIV-1 genetic diversity and drug resistance-associated mutations among drug-naive patients in Kenya prior to antiretroviral therapy (ART), a genetic analysis of HIV-1 pol-RT and env-gp41 was performed on samples collected from 53 (18 males and 35 females) consenting patients between April and June 2005. The average age, baseline CD4(+) T cell counts, and viral loads were 38 (range, 24-62) years, 475 (range, 203-799) cells/mm(3), and 4.7 (range, 3.4-5.9) log(10) copies/ml, respectively. Phylogenetic analysis revealed that 40 samples (75.5%) were concordant subtypes for the two genes and 13 (24.5%) were discordant, suggesting possible recombination and/or dual infections. Prevalent subtypes included A1/A1(pol-RT/env-gp41), 31 (58.5%); D/D, 9 (16.9%); A1/C, 2 (3.8%); A1/D, 4 (7.5%); G/A1, 2 (3.8%); A1/A2, 1 (1.9%); C/A1, 2 (3.8%); D/A1, 1(1.9%); and D/A2, 1 (1.9%). Major reverse transcriptase inhibitor (RTI) resistance-associated mutations were found in four patients (7.5%). Of these patients, three had nucleoside RTI resistance mutations, such as M184V, K65R, D67N, K70R, and K219Q. Nonnucleoside RTI resistance-associated mutations K103N and Y181C were detected in three patients and one patient, respectively. Multiple drug resistance mutations were observed in this drug-naive population. With increasing numbers of patients that require treatment and the rapid upscaling of ART in Kenya, HIV-1 drug resistance testing is recommended before starting treatment in order to achieve better clinical outcomes.
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Affiliation(s)
- Raphael W. Lihana
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
- Kanazawa University, Graduate School of Medical Sciences, Department of Viral Infection and International Health, Kanazawa, Ishikawa, Japan
| | - Samoel A. Khamadi
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Kizito Lubano
- Reproductive Health Research Unit, Center for Clinical Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Raphael Lwembe
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Michael K. Kiptoo
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Nancy Lagat
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | | | - Fredrick A. Okoth
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Elijah M. Songok
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
| | - Ernest P. Makokha
- Center for Virus Research, Kenya Medical Research Institute, Nairobi, Kenya
| | - Hiroshi Ichimura
- Kanazawa University, Graduate School of Medical Sciences, Department of Viral Infection and International Health, Kanazawa, Ishikawa, Japan
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Chan PA, Kantor R. Transmitted drug resistance in nonsubtype B HIV-1 infection. ACTA ACUST UNITED AC 2009; 3:447-465. [PMID: 20161523 DOI: 10.2217/hiv.09.30] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
HIV-1 nonsubtype B variants account for the majority of HIV infections worldwide. Drug resistance in individuals who have never undergone antiretroviral therapy can lead to early failure and limited treatment options and, therefore, is an important concern. Evaluation of reported transmitted drug resistance (TDR) is challenging owing to varying definitions and study designs, and is further complicated by HIV-1 subtype diversity. In this article, we discuss the importance of various mutation lists for TDR definition, summarize TDR in nonsubtype B HIV-1 and highlight TDR reporting and interpreting challenges in the context of HIV-1 diversity. When examined carefully, TDR in HIV-1 non-B protease and reverse transcriptase is still relatively low in most regions. Whether it will increase with time and therapy access, as observed in subtype-B-predominant regions, remains to be determined.
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Sprinz E, Netto EM, Lima MPJ, Furtado JJ, da Eira M, Zajdenverg R, Madruga JV, Lewi DS, Machado AA, Pedro RJ, Soares MA, Pedro RJ, Soares MA. Primary antiretroviral drug resistance among HIV type 1-infected individuals in Brazil. AIDS Res Hum Retroviruses 2009; 25:861-7. [PMID: 19689190 DOI: 10.1089/aid.2009.0012] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) has been documented in all countries that have surveyed for it and may result in an unfavorable response to therapy. The prevalence and characteristics of individuals with transmitted resistance to antiretroviral drugs have been scarcely described in Brazil. We performed antiretroviral resistance testing prior to initiation of therapy in 400 subjects enrolled from 20 centers in 13 Brazilian cities between March and September 2007. Genotyping was conducted using PCR-amplified HIV pol products by automated sequencing, and genotype interpretation was done according to the IAS-USA consensus. Of 400 eligible participants, 387 (95.8%) were successfully tested. Seven percent of antiretroviral-naive patients carried viruses with one or more major mutation associated with drug resistance. The prevalence of these mutations was 1.0% for protease inhibitors, 4.4% for nonnucleoside reverse transcriptase inhibitors, and 1.3% for nucleoside reverse transcriptase inhibitors. The frequency of multidrug resistance among the resistant strains was 13.6%. Among subjects infected with drug-resistant virus, the majority were infected with subtype B viruses (91%). Subjects from the city of São Paulo had higher transmitted resistance mutations compared to the rest of the country. Reporting a partner taking antiretroviral medications was associated with a higher chance of harboring HIV variants with major drug resistance mutations [odds ratio = 2.57 (95% confidence interval, 1.07-6.16); p = 0.014]. Resistance testing in drug-naive individuals identified 7% of subjects with mutations associated with reduced susceptibility to antiretroviral drugs. Continued surveillance of drug-resistant HIV-1 in Brazil is warranted when guidelines for HIV prophylaxis and treatment are updated. Resistance testing among drug-naive patients prior to treatment initiation should be considered, mainly directed at subjects whose partners are already on antiretroviral therapy.
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Affiliation(s)
- Eduardo Sprinz
- Hospital de Clínicas–Universidade Federal do Rio Grande do Sul, Porto Alegre, Brazil
| | | | | | | | | | | | | | - David S. Lewi
- Universidade Federal de São Paulo, São Paulo, Brazil
| | - Alcyone A. Machado
- Hospital das Clínicas da Faculdade de Medicina de Ribeirão Preto da Universidade de São Paulo, São Paulo, Brazil
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Ponce de Leon S, Jimenez-Corona ME, Velasco AM, Lazcano A. The Pope, condoms, and the evolution of HIV. THE LANCET. INFECTIOUS DISEASES 2009; 9:461-462. [PMID: 19628170 DOI: 10.1016/s1473-3099(09)70185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
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25
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Bracciale L, Colafigli M, Zazzi M, Corsi P, Meraviglia P, Micheli V, Maserati R, Gianotti N, Penco G, Setti M, Di Giambenedetto S, Butini L, Vivarelli A, Trezzi M, De Luca A. Prevalence of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy: evolution over 12 years and predictors. J Antimicrob Chemother 2009; 64:607-15. [PMID: 19608581 DOI: 10.1093/jac/dkp246] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Transmitted HIV-1 drug resistance (TDR) can reduce the efficacy of first-line antiretroviral therapy. PATIENTS AND METHODS A retrospective analysis was performed to assess the prevalence and correlates of TDR in Italy over time. TDR was defined as the presence of at least one of the mutations present in the surveillance drug resistance mutation (SDRM) list. RESULTS Among 1690 antiretroviral therapy-naive patients, the most frequent HIV subtypes were B (78.8%), CRF02_AG (5.6%) and C (3.6%). Overall, TDR was 15%. TDR was 17.3% in subtype B and 7.0% in non-B carriers (P < 0.001). TDR showed a slight, although not significant, decline (from 16.3% in 1996-2001 to 13.4% in 2006-07, P = 0.15); TDR declined for nucleoside reverse transcriptase inhibitors (from 13.1% to 8.2%, P = 0.003) but remained stable for protease inhibitors (from 3.7% to 2.5%, P = 0.12) and non-nucleoside reverse transcriptase inhibitors (from 3.7% to 5.8%). TDR to any drug was stable in B subtype and showed a decline trend in non-B. In multivariable analysis, F1 subtype or any non-B subtype, compared with B subtype, and higher HIV RNA were independent predictors of reduced odds of TDR. CONCLUSIONS Prevalence of TDR to nucleoside reverse transcriptase inhibitors seems to have declined in Italy over time. Increased prevalence of non-B subtypes partially justifies this phenomenon.
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Affiliation(s)
- L Bracciale
- Institute of Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy.
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Ruelle J, Jnaoui K, Lefèvre I, Lamarti N, Goubau P. Comparative evaluation of the VERSANT® HIV-1 RNA 1.0 kinetic PCR molecular system (kPCR) for the quantification of HIV-1 plasma viral load. J Clin Virol 2009; 44:297-301. [DOI: 10.1016/j.jcv.2009.01.004] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Accepted: 01/14/2009] [Indexed: 10/21/2022]
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Van Laethem K, Schrooten Y, Covens K, Dekeersmaeker N, De Munter P, Van Wijngaerden E, Van Ranst M, Vandamme AM. A genotypic assay for the amplification and sequencing of integrase from diverse HIV-1 group M subtypes. J Virol Methods 2008; 153:176-81. [PMID: 18706932 DOI: 10.1016/j.jviromet.2008.07.008] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2008] [Revised: 07/14/2008] [Accepted: 07/17/2008] [Indexed: 10/21/2022]
Abstract
Recently, the Food and Drug Administration (FDA) of the USA approved the first integrase inhibitor for inclusion in treatment regimens of HIV-1 patients failing their current regimens with multi-drug resistant strains. However, treatment failure has been observed during integrase inhibitor-containing therapy. Several mutational pathways have been described with signature mutations at integrase positions 66, 92, 148 and 155. Therefore, a genotypic assay for the amplification and sequencing of HIV-1 integrase was developed. The assay displayed a detection limit of 10 HIV-1 III(B) RNA copies/ml plasma. As the HIV-1 pandemic is characterised by a large genetic diversity, the new assay was evaluated on a panel of 74 genetically divergent samples belonging to the following genetic forms A, B, C, D, F, G, J, CRF01-AE, CRF02-AG, CRFF03-AB, CRF12-BF and CRF13-cpx. Their viral load ranged from 178 until >500,000 RNA copies/ml. The amplification and sequencing was successful for 70 samples (a success rate of 95%). The four failures were most probably due to low viral load or poor quality of RNA and not to subtype issues. Some of the sequences obtained from integrase inhibitor-naïve patients displayed polymorphisms at integrase positions associated with resistance: 74IV, 138D, 151I, 157Q and 163AE. The relevance of these polymorphisms in the absence of the signature mutations remains unclear.
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Affiliation(s)
- Kristel Van Laethem
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium.
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Vercauteren J, Deforche K, Theys K, Debruyne M, Duque LM, Peres S, Carvalho AP, Mansinho K, Vandamme AM, Camacho R. The incidence of multidrug and full class resistance in HIV-1 infected patients is decreasing over time (2001-2006) in Portugal. Retrovirology 2008; 5:12. [PMID: 18241328 PMCID: PMC2265747 DOI: 10.1186/1742-4690-5-12] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2007] [Accepted: 02/01/2008] [Indexed: 11/20/2022] Open
Abstract
Despite improvements in HIV treatment, the prevalence of multidrug resistance and full class resistance is still reported to be increasing. However, to investigate whether current treatment strategies are still selecting for multidrug and full class resistance, the incidence, instead of the prevalence, is more informative. Temporal trends in multidrug resistance (MDR defined as at most 1 drug fully susceptible) and full class resistance (FCR defined as no drug in this class fully susceptible) in Portugal based on 3394 viral isolates genotyped from 2000 to 2006 were examined using the Rega 6.4.1 interpretation system. From July 2001 to July 2006 there was a significant decreasing trend of MDR with 5.7%, 5.2%, 3.8%, 3.4% and 2.7% for the consecutive years (P = 0.003). Multivariate analysis showed that for every consecutive year the odds of having a new MDR case decreased with 20% (P = 0.003). Furthermore, a decline was observed for NRTI- and PI-FCR (both P < 0.001), whereas for NNRTI-FCR a parabolic trend over time was seen (P < 0.001), with a maximum incidence in 2003–'04. Similar trends were obtained when scoring resistance for only one drug within a class or by using another interpretation system. In conclusion, the incidence of multidrug and full class resistance is decreasing over time in Portugal, with the exception of NNRTI full class resistance which showed an initial rise, but subsequently also a decline. This is most probably reflecting the changing drug prescription, the increasing efficiency of HAART and the improved management of HIV drug resistance. This work was presented in part at the Eighth International Congress on Drug Therapy in HIV Infection, Glasgow (UK), 12-16 November 2006 (PL5.5); and at the Fifth European HIV Drug Resistance Workshop, Cascais (Portugal), 28-30 March 2007 (Abstract 1).
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