We assessed HIV drug resistance (DR) in individuals failing
ART (acquired DR, ADR) and in ART-naïve individuals (pre-ART DR, PDR) in
Honduras, after 10 years of widespread availability of ART.
365 HIV-infected, ART-naïve, and 381 ART-experienced
Honduran individuals were enrolled in 5 reference centres in Tegucigalpa, San
Pedro Sula, La Ceiba, and Choluteca between April 2013 and April 2015. Plasma
HIV protease-RT sequences were obtained. HIVDR was assessed using the WHO HIVDR
mutation list and the Stanford algorithm. Recently infected (RI) individuals
were identified using a multi-assay algorithm.
PDR to any ARV drug was 11.5% (95% CI 8.4–15.2%). NNRTI PDR
prevalence (8.2%) was higher than NRTI (2.2%) and PI (1.9%, p<0.0001). No
significant trends in time were observed when comparing 2013 and 2014, when
using a moving average approach along the study period or when comparing
individuals with >500 vs. <350 CD4+ T cells/μL. PDR in recently infected
individuals was 13.6%, showing no significant difference with PDR in
individuals with longstanding infection (10.7%). The most prevalent PDR
mutations were M46IL (1.4%), T215 revertants (0.5%), and K103NS (5.5%). The
overall ADR prevalence in individuals with <48 months on ART was 87.8% and
for the ≥48 months on ART group 81.3%. ADR to three drug families increased in
individuals with longer time on ART (p = 0.0343). M184V and K103N were the most
frequent ADR mutations. PDR mutation frequency correlated with ADR mutation
frequency for PI and NNRTI (p<0.01), but not for NRTI. Clusters of viruses
were observed suggesting transmission of HIVDR both from ART-experienced to
ART-naïve individuals and between ART-naïve individuals.
The global PDR prevalence in Honduras remains at the
intermediate level, after 10 years of widespread availability of ART. Evidence
of ADR influencing the presence of PDR was observed by phylogenetic analyses
and ADR/PDR mutation frequency correlations.
Below: HIVDR mutation
frequency comparison in individuals with recent and longstanding infection. Recently
infected individuals were identified using a multi-assay algorithm as described
in Methods. Only mutations present in any of the comparison groups are shown.
Mutations considered for the analysis include WHO TDR surveillance mutations as
well as mutations contributing with penalty scores in the Stanford algorithm.
For a comprehensive list of mutations considered refer to Table 4.
NRTI, Nucleoside RT Inhibitors; NNRTI, Non-nucleoside RT Inhibitors; PI,
protease inhibitors; * p<0.05 Fisher’s exact test.
Below: Correlations between
PDR and ADR mutation frequency in Honduras. Pearson correlation
coefficients were calculated for PDR mutation frequency vs. ADR mutation
frequency at <48 and ≥48 months on ART, for the whole study period, for all
DR mutations together and dividing them into ARV families. Each point
represents one mutation. Some of the most relevant DR mutations are shown. PDR,
pre-antiretroviral treatment drug resistance; ADR, acquired drug resistance;
NRTI, Nucleoside RT Inhibitors; NNRTI, Non-nucleoside RT Inhibitors; PI,
protease inhibitors.
Full article at: http://goo.gl/uHQ8dl
By:
Santiago Avila-Ríos, Claudia García-Morales, Daniela
Tapia-Trejo, Gustavo Reyes-Terán
Centre for Research in
Infectious Diseases, National Institute of Respiratory Diseases, Mexico City,
Mexico
Rita I. Meza, Sandra M. Nuñez, Leda Parham
HIV National Programme and
National Laboratory, Honduran Ministry of Health, Tegucigalpa, Honduras
Norma A. Flores
Instituto Nacional Cardio
Pulmonar, Tegucigalpa, Honduras
Diana Valladares, Luisa M. Pineda
Hospital Mario Catarino Rivas,
San Pedro Sula, Honduras
Dixiana Flores, Roxana Motiño
Unidad de Salud Metropolitana,
La Ceiba, Honduras
Víctor Umanzor
Hospital del Sur, Choluteca,
Honduras
Candy Carbajal, Wendy Murillo, Ivette Lorenzana, Elsa Y.
Palou
Universidad Nacional Autónoma de
Honduras, Tegucigalpa, Honduras
Elsa Y. Palou
Hospital Escuela Universitario,
Tegucigalpa, Honduras
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