HIV-1 Antiretroviral Drug Resistance Mutations in Treatment Naïve and Experienced Panamanian Subjects: Impact on National Use of EFV-Based Schemes

• Published in: PloS one Vol. 11; no. 4; p. e0154317
• Main Authors: Mendoza, Yaxelis, Castillo Mewa, Juan, Martínez, Alexander A, Zaldívar, Yamitzel, Sosa, Néstor, Arteaga, Griselda, Armién, Blas, Bautista, Christian T, García-Morales, Claudia, Tapia-Trejo, Daniela, Ávila-Ríos, Santiago, Reyes-Terán, Gustavo, Bello, Gonzalo, Pascale, Juan M
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 27.04.2016; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adult; Aged; AIDS; Anti-HIV Agents - pharmacology; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Benzoxazines - pharmacology; Biology and Life Sciences; Drug resistance; Drug Resistance, Viral - genetics; Efavirenz; Female; Gene sequencing; Genotype; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; HIV Reverse Transcriptase - genetics; HIV-1 - genetics; Human immunodeficiency virus; Humans; Lamivudine; Levels; Male; Medical diagnosis; Medicine and Health Sciences; Middle Aged; Mutation; Nevirapine; Nevirapine - pharmacology; Nucleosides; Panama; People and places; Pol gene; Prevalence; Protease inhibitors; Proteinase inhibitors; Retrospective Studies; RNA-directed DNA polymerase; Surveillance; Young Adult
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0154317

The use of antiretroviral therapy in HIV infected subjects prevents AIDS-related illness and delayed occurrence of death. In Panama, rollout of ART started in 1999 and national coverage has reached 62.8% since then. The objective of this study was to determine the level and patterns of acquired drug resistance mutations of clinical relevance (ADR-CRM) and surveillance drug resistance mutations (SDRMs) from 717 HIV-1 pol gene sequences obtained from 467 ARV drug-experienced and 250 ARV drug-naïve HIV-1 subtypes B infected subjects during 2007-2013, respectively. The overall prevalence of SDRM and of ADR-CRM during the study period was 9.2% and 87.6%, respectively. The majority of subjects with ADR-CRM had a pattern of mutations that confer resistance to at least two classes of ARV inhibitors. The non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations K103N and P225H were more prevalent in both ARV drug-naïve and ARV drug-experienced subjects. The nucleoside reverse transcriptase inhibitor (NRTI) mutation M184V was more frequent in ARV drug-experienced individuals, while T215YFrev and M41L were more frequent in ARV drug-naïve subjects. Prevalence of mutations associated to protease inhibitors (PI) was lower than 4.1% in both types of subjects. Therefore, there is a high level of resistance (>73%) to Efavirenz/Nevirapine, Lamivudine and Azidothymidine in ARV drug-experienced subjects, and an intermediate to high level of resistance (5-10%) to Efavirenz/Nevirapine in ARV drug-naïve subjects. During the study period, we observed an increasing trend in the prevalence of ADR-CRM in subjects under first-line schemes, but not significant changes in the prevalence of SDRM. These results reinforce the paramount importance of a national surveillance system of ADR-CRM and SDRM for national management policies of subjects living with HIV.