HIV Pretreatment Drug Resistance Trends in Mexico City, 2017–2020

Abstract

In response to increasing pretreatment drug resistance (PDR), Mexico changed its national antiretroviral treatment (ART) policy, recommending and procuring second-generation integrase strand-transfer inhibitor (INSTI)-based regimens as preferred first-line options since 2019. We present a four-year observational study describing PDR trends across 2017–2020 at the largest HIV diagnosis and primary care center in Mexico City. A total of 6688 baseline protease-reverse transcriptase and 6709 integrase sequences were included. PDR to any drug class was 14.4% (95% CI, 13.6–15.3%). A significant increasing trend for efavirenz/nevirapine PDR was observed (10.3 to 13.6%, p = 0.02). No increase in PDR to second-generation INSTI was observed, remaining under 0.3% across the study period. PDR was strongly associated with prior exposure to ART (aOR: 2.9, 95% CI: 1.9–4.6, p < 0.0001). MSM had higher odds of PDR to efavirenz/nevirapine (aOR: 2.0, 95% CI: 1.0–3.7, p = 0.04), reflecting ongoing transmission of mutations such as K103NS and E138A. ART restarters showed higher representation of cisgender women and injectable drug users, higher age, and lower education level. PDR to dolutegravir/bictegravir remained low in Mexico City, although further surveillance is warranted given the short time of ART optimization. Our study identifies demographic characteristics of groups with higher risk of PDR and lost to follow-up, which may be useful to design differentiated interventions locally.

Pretreatment HIV Drug Resistance and the Molecular Transmission Network Among HIV-Positive Individuals in China in 2022: Multicenter Observational Study

“…Results of the multivariable analysis indicated that individuals who had prior ARV drug exposure had 7.45 times greater odds of PDR compared to those without prior ARV drug exposure. Such findings are consistent with research from Mexico, African countries, and Northeast China [ 42 - 44 ]. There was an increasing trend of the proportion of CRF55_01B samples, rising from 2.3% in 2015 to 3.9% in 2018 and 4.1% in 2022 in China [ 34 ].…”

HIV-1 Low-Frequency Variants Identified in Antiretroviral-Naïve Subjects with Virologic Failure after 12 Months of Follow-Up in Panama

“…A few accessory mutations were identified in the integrase region, and no major level resistance was observed, consistent with other studies [ 17 , 18 , 19 ]. The L74M polymorphic mutation was commonly observed with a frequency of 0.5–20%, decreasing the effectiveness of the first- and second-generation INSTI drugs, as was previously reported in Brazil in a study of PDR on ART-naïve subjects [ 20 ].…”

Retrospective Study on Genetic Diversity and Drug Resistance among People Living with HIV at an AIDS Clinic in Beijing

“…These findings align with studies conducted in Tianjin [ 32 ] and Cameroon [ 33 ]. It has been widely reported that EFV and NVP, as first-line drugs, are frequently associated with the development of resistance [ 33 , 34 ].…”

“…After excluding 145 ART-naive individuals without sequence results, the final analysis included 1640 ART-naive individuals for PDR analysis and 569 ARTexperienced individuals for ADR analysis. Among the 1640 ART-naive individuals, the median age was 31 years (interquartile range (IQR) [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The majority of participants were male (97.0%, 1590/1640), while a smaller proportion were female (3.5%, 50/1640).…”

“…age was 31 years (interquartile range (IQR) [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40]. The majority of participants were male (97.0%, 1590/1640), while a smaller proportion were female (3.5%, 50/1640).…”