Characteristics of Transmitted Drug-Resistant HIV-1 in Recently Infected Treatment-Naïve Patients in Japan

Progress in antiretroviral treatment has led to fewer virological failure cases, but 10 to 20% of treatment-naive HIV/AIDS cases are reported to harbor drug-resistant strains, suggesting transmission of drug-resistant HIV. We aimed to determine the trend in prevalence of transmitted drug-resistant (TDR) HIV in Japan, particularly in recently infected patients.

Drug resistance test was performed on 3904 HIV-1-infected cases newly diagnosed between 2007 and 2012. The number of cases infected within 6 months (recent seroconverters, RS) was estimated by BED assay of 2700 plasma samples. Characteristics of RS cases were further analyzed.

The overall prevalence of TDR was 9.1%, ranging from 7.3% in 2008 to 12.5% in 2010. Among 1403 subtype B/E/D cases with >50 CD4 T cell counts and >1000 HIV copies/ml, 468 (33.4%) were estimated to be RS. The prevalence of RS was significantly higher among cases who were male, Japanese, and men who have sex with men (MSM). The prevalence of TDR did not differ significantly between recent and long-term seroconverters (8.5% vs. 9.2%, respectively, p=0.68). Common mutations in both groups were M46I/L and T215 revertants. Furthermore, sequences with these mutations, K103N and D30N/N88D formed clusters on phylogenetic trees.

Our study clarified an increase in prevalence of TDR in Japan from 2007 to 2012. The phylogenetic clustering of cases with M46I/L or T215 revertants suggests that HIV with these mutations have become circulating strains. Further, detailed analyses showed that Japanese MSM are more aware of their risk of HIV infection.

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By: Hattori J1, Shiino T, Gatanaga H, Mori H, Minami R, Uchida K, Sadamasu K, Kondo M, Sugiura W; Japanese Drug Resistance HIV-1 Surveillance Network.

• 11Clinical Research Center, National Hospital Organization Nagoya Medical Center, Nagoya, Japan; 2Infectious Disease Surveillance Center, National Institute of Infectious Diseases, Tokyo, Japan; 3National Center for Global Health and Medicine, Tokyo, Japan; 4Osaka Prefectural Institute of Public Health, Osaka, Japan; 5National Hospital Organization Kyushu Medical Center, Fukuoka, Japan; 6Saitama Institute of Public Health; 7Tokyo Metropolitan Institute of Public Health, Tokyo, Japan; 8Kanagawa Prefectural Institute of Public Health, Chigasaki, Japan; 9Division of Basic Medicine, Nagoya University Graduate School of Medicine, Nagoya, Japan. 

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