National Prevalence and Trends of HIV Transmitted Drug Resistance in Mexico

Santiago Avila-Ríos,Daniela Garrido-Rodríguez,Gustavo Reyes-Terán,Luz A González-Hernández,Claudia García-Morales,Indiana Torres-Escobar,Christopher E Ormsby,Samuel Navarro-Álvarez,Jaime Andrade-Villanueva,Ramón Hernández-Juan,Luwen Zhang

doi:10.1371/journal.pone.0027812

Abstract

BackgroundTransmitted drug resistance (TDR) remains an important concern for the management of HIV infection, especially in countries that have recently scaled-up antiretroviral treatment (ART) access.Methodology/Principal FindingsWe designed a study to assess HIV diversity and transmitted drug resistance (TDR) prevalence and trends in Mexico. 1655 ART-naïve patients from 12 Mexican states were enrolled from 2005 to 2010. TDR was assessed from plasma HIV pol sequences using Stanford scores and the WHO TDR surveillance mutation list. TDR prevalence fluctuations over back-projected dates of infection were tested. HIV subtype B was highly prevalent in Mexico (99.9%). TDR prevalence (Stanford score>15) in the country for the study period was 7.4% (95% CI, 6.2∶8.8) and 6.8% (95% CI, 5.7∶8.2) based on the WHO TDR surveillance mutation list. NRTI TDR was the highest (4.2%), followed by NNRTI (2.5%) and PI (1.7%) TDR. Increasing trends for NNRTI (p = 0.0456) and PI (p = 0.0061) major TDR mutations were observed at the national level. Clustering of viruses containing minor TDR mutations was observed with some apparent transmission pairs and geographical effects.ConclusionsTDR prevalence in Mexico remains at the intermediate level and is slightly lower than that observed in industrialized countries. Whether regional variations in TDR trends are associated with differences in antiretroviral drug usage/ART efficacy or with local features of viral evolution remains to be further addressed.

Highlights

Antiretroviral therapy (ART) has radically decreased HIVassociated morbidity and mortality in countries where broad access to antiretroviral (ARV) drugs has been achieved
Transmitted drug resistance (TDR) prevalence in Mexico remains at the intermediate level and is slightly lower than that observed in industrialized countries
Whether regional variations in TDR trends are associated with differences in antiretroviral drug usage/antiretroviral treatment (ART) efficacy or with local features of viral evolution remains to be further addressed

Summary

Introduction

Antiretroviral therapy (ART) has radically decreased HIVassociated morbidity and mortality in countries where broad access to antiretroviral (ARV) drugs has been achieved. Most patients in this setting are starting ART on potent regimens, possibly delaying transmission of drug-resistant HIV strains as compared with highincome countries, where ART scale-up began with suboptimal and lower-potency regimes [11]. This hypothesis is supported by the observation of stabilizing or decreasing tendencies in TDR in some developed countries during the last few years, which could be reflecting the more recent broad use of high-potency ART regimes [1,12,13,14]. Transmitted drug resistance (TDR) remains an important concern for the management of HIV infection, especially in countries that have recently scaled-up antiretroviral treatment (ART) access

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Discussion

Conclusion