Emergence of drug resistance in human immunodeficiency virus type 1 infected patients from pune, India, at the end of 12 months of first line antiretroviral therapy initiation.

Rajesh T Patil,Sourav Sen,Srikanth P Tripathy,Rajiv M Gupta,Nitin K Hingankar,Ramesh S Paranjape,Devidas N Chaturbhuj

doi:10.1155/2014/674906

Rajesh T Patil, Sourav Sen + Show 5 more

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Introduction. In India, 4,86,173 HIV infected patients are on first line antiretroviral therapy (ART) as of January 2012. HIV drug resistance (HIVDR) is drug and regimen-specific and should be balanced against the benefits of providing a given ART regimen. Material & Methods. The emergence of HIVDR mutations in a cohort of 100 consecutive HIV-1 infected individuals attending ART centre, on first line ART for 12 months, was studied. CD4+ T-cell counts and plasma HIV-1 RNA level were determined. Result. Out of the 100 HIV-1 infected individuals, 81 showed HIVDR prevention (HIV-1 RNA level < 1000/mL), while the remaining 19 had HIV-1 viral RNA level > 1000/mL. HIVDR genotyping was carried out for individuals with evidence of virologic failure (HIV-1 RNA level > 1000/mL). The most frequent NRTI-associated mutation observed was M184V, while K103N/S was the commonest mutation at NNRTI resistance position. Conclusion. Our study has revealed the emergence of HIVDR in HIV-1 infected patients at the end of 12 months of first line ART initiation. For NRTIs, the prevalence of HIVDR mutations was 9% and 10% for NNRTIs. Our findings will contribute information in evidence-based decision making with reference to first and second line ART delivery and prevention of HIVDR emergence.

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In India, 4,86,173 human immunodeficiency virus (HIV) infected patients are on first line antiretroviral therapy (ART) as of January 2012
Because of the error-prone nature of HIV replication, its high mutation rate in the presence of drug selective pressure, and because of the need for lifelong treatment, it is anticipated that drug resistant (HIVDR) HIV strains will emerge among persons on treatment even if appropriate ART regimens are provided and optimal adherence to therapy is supported [5]
Studies have shown that the second line nucleoside reverse transcriptase inhibitor (NRTI) drugs like tenofovir, abacavir, and didanosine and nonnucleoside reverse transcriptase inhibitor (NNRTI) drugs like etravirine will be rendered ineffective if these PLHA harbouring HIV drug resistance (HIVDR) mutations are continued on a failing regimen [10]

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Introduction

In India, 4,86,173 HIV infected patients are on first line antiretroviral therapy (ART) as of January 2012. Our study has revealed the emergence of HIVDR in HIV-1 infected patients at the end of 12 months of first line ART initiation. HIV drug resistant mutations in patients on ART can occur before or after virologic failure and can continue to occur and ISRN AIDS get selected under drug pressure if the failed regimen is not replaced [7]. Due to the high cost of the plasma virus load determination, monitoring of HIV RNA levels in HIV infected patients on first line ART is still not offered as a standard of care test in resource limited settings. This study was carried out to evaluate the emergence of HIVDR in 100 HIV-1 infected individuals at the end of 12 months of initiation of first line ART

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