Abstract
IntroductionIn Brazil, more than 487,450 individuals are currently undergoing antiretroviral treatment. In order to monitor the transmission of drug‐resistant strains and HIV subtype distribution in the country, this work aimed to estimate its prevalence and to characterize the nationwide pretreatment drug resistance in individuals recently diagnosed with HIV between 2013 and 2015.MethodsThe HIV threshold survey methodology (HIV‐THS, WHO) targeting antiretroviral‐naive individuals with recent HIV diagnosis was utilized, and subjects were selected from 51 highly populated cities in all five Brazilian macroregions. The HIV pol genotypic test was performed by genomic sequencing.ResultsWe analysed samples from 1568 antiretroviral‐naive individuals recently diagnosed with HIV, and the overall transmitted drug resistance (TDR) prevalence was 9.5% (150 sequences). The regional prevalence of resistance according to Brazilian geographical regions was 9.4% in the northeast, 11.2% in the southeast, 6.8% in the central region, 10.2% in the north and 8.8% in the south. The inhibitor‐specific TDR prevalence was 3.6% for nucleoside reverse transcriptase inhibitors (NRTIs), 5.8% for non‐nucleoside reverse transcriptase inhibitors (NNRTIs) and 1.6% for protease inhibitors (PIs); 1.0% of individuals presented resistance to more than one class of inhibitors. Overall, subtype B was more prevalent in every region except for the southern, where subtype C prevails.ConclusionsTo the best of our knowledge, this is the first TDR study conducted in Brazil with nationwide representative sampling. The TDR prevalence revealed a moderate rate in the five Brazilian geographical regions, although some cities presented higher TDR prevalence rates, reaching 14% in São Paulo, for example. These results further illustrate the importance of surveillance studies for designing future strategies in primary antiretroviral therapy, aiming to mitigate TDR, as well as for predicting future trends in other regions of the globe where mass antiretroviral (ARV) treatment was implemented.
Highlights
In Brazil, more than 487,450 individuals are currently undergoing antiretroviral treatment
The Brazilian Ministry of Health implemented, in 1996, a pioneering programme for the care and support of people living with HIV/AIDS, which encompasses free universal access to antiretroviral drugs for HIV-infected individuals
In a similar study done in Argentina, researchers found 14% of transmitted drug resistance (TDR) and 11% of nucleoside reverse transcriptase inhibitors (NNRTIs) DRM [25]
Summary
In Brazil, more than 487,450 individuals are currently undergoing antiretroviral treatment. Results: We analysed samples from 1568 antiretroviral-naive individuals recently diagnosed with HIV, and the overall transmitted drug resistance (TDR) prevalence was 9.5% (150 sequences). The TDR prevalence revealed a moderate rate in the five Brazilian geographical regions, some cities presented higher TDR prevalence rates, reaching 14% in S~ao Paulo, for example. These results further illustrate the importance of surveillance studies for designing future strategies in primary antiretroviral therapy, aiming to mitigate TDR, as well as for predicting future trends in other regions of the globe where mass antiretroviral (ARV) treatment was implemented. A recent study analysed samples from 26 European countries and reported an overall prevalence of TDR of 8.3%. In middleand low-income countries, the prevalence of TDR is around 7.0%, estimated at 6.3% in Latin America [4], 5.7% in India [10] and less than 5.0% in major African countries, including Angola, Botswana, South Africa, Uganda, Zimbabwe and Chad [11]
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