High frequency of antiviral drug resistance and non-B subtypes in HIV-1 patients failing antiviral therapy in Cuba

Abstract Background Emergence of HIV-1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options. Objectives Surveillance of drug resistance and subtypes in HIV-1 patients failing ART in Cuba. Study design This st...

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Bibliographic Details
Published in:Journal of clinical virology 2012-12, Vol.55 (4), p.348-355
Main Authors: Kourí, Vivian, Alemán, Yoan, Pérez, Lissette, Pérez, Jorge, Fonseca, Carlos, Correa, Consuelo, Aragonés, Carlos, Campos, Jorge, Álvarez, Delmis, Schrooten, Yoeri, Dekeersmaeker, Nathalie, Imbrechts, Stijn, Beheydt, Gertjan, Vinken, Lore, Pérez, Daniel, Álvarez, Alina, Soto, Yudira, Vandamme, Anne-Mieke, Van Laethem, Kristel
Format: Article
Language:English
Subjects:
Adult
Allergy and Immunology
Anti-HIV Agents - pharmacology
Antiretroviral therapy
Antiviral agents
Biological and medical sciences
Cuba
Cuba - epidemiology
Data processing
Drug resistance
Drug Resistance, Viral
Fc receptors
Female
Fundamental and applied biological sciences. Psychology
Genotype
Genotyping
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - virology
HIV-1 - classification
HIV-1 - drug effects
HIV-1 - genetics
HIV-1 - isolation & purification
Human immunodeficiency virus 1
Human viral diseases
Humans
Infectious Disease
Infectious diseases
Male
Medical sciences
Microbiology
Middle Aged
Miscellaneous
Molecular Epidemiology
Multidrug resistance
Mutation
nucleoside reverse transcriptase inhibitors
Prevalence
Proteinase inhibitors
Recombinants
Resistance
Treatment Failure
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Virology
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Summary:Abstract Background Emergence of HIV-1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options. Objectives Surveillance of drug resistance and subtypes in HIV-1 patients failing ART in Cuba. Study design This study compiled data of ART-experienced HIV-1 patients attending a clinical center in Havana in 2003 and 2009–2011. The first period included results of a cross-sectional study, whereas in the second period genotyping was performed as part of routine care. Drug resistance mutations and levels were determined using HIVdb version 6.0.9. Results Seventy-six percent received solely ART containing at least 3 drugs, of which 79.1% ever receiving unboosted protease inhibitors (PI). Patients from 2009 to 2011 were longer treated and exposed to more ART regimens. Subtype B (39%) and CRF19_cpx (18%) were the most prevalent genetic forms. Subtype distribution did not change significantly between both periods, except for BG recombinants that increased from 6% to 14%. Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside RTI (NNRTI) and PI mutations were present in 69.5%, 54.8% and 44.4%. Full-class resistance (FCR) to NRTI, NNRTI, PI and multidrug resistance (MDR) were detected in 31.8%, 37.9%, 18.5% and 15.4%. FCR to NRTI, NNRTI, PI and MDR were present in 9.8%, 14.1%, 0%, 0% after first-line failure and in 19.8%, 20.8%, 2.9% and 2.9% after second-line failure. Conclusions Our study found a high prevalence of drug resistance and supports the need for appropriate laboratory monitoring in clinical practice and access to drug options in case of virological failure.
ISSN:1386-6532
1873-5967
DOI:10.1016/j.jcv.2012.08.019