Abstract
BackgroundThe emergence and transmission of HIV-1 drug resistance (HIVDR) has raised concerns after rapid global antiretroviral therapy (ART) scale-up. There are limited data on the epidemiology of primary HIVDR in resource-limited settings in Asia. We aimed to determine the prevalence and compare the distribution of HIVDR in a cohort of ART-naïve Asian patients with recent and chronic HIV-1 infection.MethodsMulticenter prospective study was conducted in ART-naïve patients between 2007 and 2010. Resistance-associated mutations (RAMs) were assessed using the World Health Organization 2009 list for surveillance of primary HIVDR.ResultsA total of 458 patients with recent and 1,340 patients with chronic HIV-1 infection were included in the analysis. The overall prevalence of primary HIVDR was 4.6%. Recently infected patients had a higher prevalence of primary HIVDR (6.1% vs. 4.0%, p = 0.065) and frequencies of RAMs to protease inhibitors (PIs; 3.9% vs. 1.0%, p<0.001). Among those with recent infection, the most common RAMs to nucleoside reverse transcriptase inhibitors (NRTIs) were M184I/V and T215D/E/F/I/S/Y (1.1%), to non-NRTIs was Y181C (1.3%), and to PIs was M46I (1.5%). Of patients with chronic infection, T215D/E/F/I/S/Y (0.8%; NRTI), Y181C (0.5%; non-NRTI), and M46I (0.4%; PI) were the most common RAMs. K70R (p = 0.016) and M46I (p = 0.026) were found more frequently among recently infected patients. In multivariate logistic regression analysis in patients with chronic infection, heterosexual contact as a risk factor for HIV-1 infection was less likely to be associated with primary HIVDR compared to other risk categories (odds ratio 0.34, 95% confidence interval 0.20–0.59, p<0.001).ConclusionsThe prevalence of primary HIVDR was higher among patients with recent than chronic HIV-1 infection in our cohort, but of borderline statistical significance. Chronically infected patients with non-heterosexual risks for HIV were more likely to have primary HIVDR.
Highlights
Active antiretroviral therapy (ART) has significantly improved the prognosis of HIV-1-infected patients and prolonged survival worldwide [1,2,3]
We aimed to compare the prevalence of primary HIV-1 drug resistance (HIVDR) and the distribution of frequencies of Resistanceassociated mutations (RAMs) in these cohorts; and to determine factors associated with primary HIVDR
The present study showed an overall prevalence of primary HIVDR of almost 5%, which is categorized as low prevalence by WHO criteria
Summary
Active antiretroviral therapy (ART) has significantly improved the prognosis of HIV-1-infected patients and prolonged survival worldwide [1,2,3]. Since 2004, the number of people receiving therapy has increased substantially, and exceeded 5 million people in low- and middle-income countries in 2010 [3]. The epidemic within the Asia-Pacific region includes largely concentrated epidemics that vary by transmission risk factors. ART was available in high-income countries in the region at similar times to Western countries, including use of protease inhibitors (PI). The emergence and transmission of HIV-1 drug resistance (HIVDR) has raised concerns after rapid global antiretroviral therapy (ART) scale-up. We aimed to determine the prevalence and compare the distribution of HIVDR in a cohort of ART-naıve Asian patients with recent and chronic HIV-1 infection
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