HIV Genotypes and Primary Drug Resistance Among HIV-Seropositive Blood Donors in Brazil

Abstract

Background There are few surveillance studies analyzing genotypes or primary (transmitted) drug resistance in HIV-infected blood donors in Brazil. The aim of this study was to characterize patterns of HIV genotypes and primary resistance among HIV seropositive donors identified at 4 geographically dispersed blood centers in Brazil. Methods All HIV-infected donors who returned for counseling at the 4 REDS-II Hemocenters in Brazil from January 2007–March 2011 were invited to participate in a case-control study involving a questionnaire on risk factors. Viral sequencing was also offered to positive cases to assign genotypes and to detect and characterize primary resistance to RT and protease inhibitors according to WHO guidelines. Results Of the 341 HIV seropositive donors who consented to participate in the risk-factor and genetics study, pol sequences were obtained for 331 (97%). Clade B was predominant (76%) followed by F (15%) and C (5%). Primary resistance was present in 36 (12.2%; 95% confidence interval [CI] 8.2,15.5) of the 303 individuals not exposed to antiretroviral therapy (ART), varying from 8.2% (95%CI 2,7,13.6) in Recife to 19.4% in São Paulo (95%CI 9.5,29.2); there were no significant correlations with other demographics or risk factors. Conclusion Although subtype B remains the most prevalent genotype in all 4 areas, increasing rates of subtype C in Sao Paulo and F in Recife were documented relative to earlier reports. Transmitted drug resistance was relatively frequent, particularly in the city of Sao Paulo which showed an increase compared to previous HIV seropositive donor data from 10 years ago.

Deep Sequencing of HIV-1 near Full-Length Proviral Genomes Identifies High Rates of BF1 Recombinants Including Two Novel Circulating Recombinant Forms (CRF) 70_BF1 and a Disseminating 71_BF1 among Blood Donors in Pernambuco, Brazil

“…A total of 26 strains preliminarily classified as subclade F1 (n = 25) and BF1 recombinant (n = 1) by sequence analysis of a partial pol region in a previous study [17] were corroborated by further phylogenetic analysis of the NFLGs and larger partial fragments. Of note, one BF1 sample (10BR_PE059) was erroneously classified as F1 in our previous study.…”

“…Again, these data confirms that infection in this subject was founded by two genetic lineages. In Figure 5 , there were three samples (10BR_PE002 (pro), 10BR_PE032 [17] , and 10BR_PE102 [17] , which shared one breakpoint at the integrase gene (position 2393–2462 nt), similar to the third breakpoint of the CRF71_BF variants (5′ of fragment F2 , Figure 2 ). This increased prevalence of genetic breakpoints in the integrase region may indicate a possible preference region for recombination to occur.…”

“…The 24 peripheral blood mononucleated cells (PBMCs) samples reported in this study were from HIV-1 seropositive blood donors in Recife, capital of Pernambuco in the northeast region of Brazil. The rationale for collection of these samples has been previously reported [17] . No evidence of direct epidemiological linkage could be established.…”

“…Data from recent studies of the viral near full-length genomes (NFLGs) have provided evidence of Brazilian CRF strains designated as CRF28_BF, CRF29_BF, CRF39_BF, CRF40_BF, CRF46_BF and CRF31_BC [12] , [13] , [15] , [16] . Recently, Alencar et al [17] performed a molecular epidemiological survey of HIV-1 in Brazil and analyzed the partial pol gene of 341 samples from seropositive blood donors collected between 2007 and 2011 from 4 Brazilian blood centers of the REDS-II (Retrovirus Epidemiological Donor Study) international program. The study reported a relatively high prevalence of subclade F1 (26 [24%] of 110), and only one case of BF1 recombinant among blood donors from Recife, Pernambuco (PE).…”

Contribution of the Retrovirus Epidemiology Donor Study (REDS) to research on blood transfusion safety in Brazil

“…Thus, ACASI elicited increased disclosure of HIV risk factors among blood donors and may be a valuable modality of interview to be introduced in Brazilian blood banks 21 . The REDS-II study also allowed us to characterize the HIV subtypes and the primary resistance of HIV-positive donors from the three REDS-II Brazilian blood centers and the blood center of Rio de Janeiro, in accordance with their demographic and exposure risk 22 . HIV Subtype B was the most prevalent in these centers, however an increased proportion of non-B subtypes was observed in later years of the study.…”