The Evolving Genotypic Profile of HIV-1 Mutations Related to Antiretroviral Treatment in the North Region of Brazil

Abstract

HIV related mutations can be associated with decreased susceptibility to antiretrovirals and treatment failures. There is scarce information about HIV mutations in persons failing HIV treatment in North of Brazil. Our aim was to evaluate evolution of HIV subtypes and mutations patterns related to antiretroviral therapy in this region. We investigated HIV resistance profile in adults failing antiretroviral regimen in Northern Brazil from January, 2004, through December, 2013. Genotype data was evaluated through Stanford University algorithm. There were 377 genotypes from different individuals to evaluate. Resistance mutations were similar to worldwide reports and related to antiretroviral exposure. Most prevalent mutations in the reverse transcriptase gene were M184V (80.1%) and K130N (40.6%). Thymidine associated mutations were more frequent in multiexperienced patients. Most common protease mutations were M46I, V82A, I54V, L90M, I84V, M46L, and L76V. Subtype B was the most prevalent (90.7%). There were differences between subtypes B and non-B mutations. We documented for the first time subtypes and patterns of HIV associated mutations in Northern Brazil. A1 subtype was identified for the first time in this area. Depending on drug regimen and how experienced the patient is, an empirical switch of a failing antiretroviral treatment could be a reasonable option.

Virologic suppression in response to antiretroviral therapy despite extensive resistance within HIV-1 reverse transcriptase after the first virologic failure

“…Similar to our results, the high prevalence of M184 V/I mutations was reported in several regions of Brazil [ 11 , 25 , 40 ], in Sub-Saharan Africa [ 26 ] and in Asia [ 27 ], but to a lesser extent in western Europe [ 28 ]. This difference can be explained by the use of emtricitabine in European countries and by the use of lamivudine in low- and middle-income settings.…”

HIV-1 genetic diversity and antiretroviral drug resistance among individuals from Roraima state, northern Brazil

“…These results indicate that the HIV-1 molecular epidemiologic profile observed in Roraima is much more homogenous than that described in any other Brazilian state, even from the Northern region [ 8 , 18 , 29 – 33 ], but comparable to that described in the neighboring country of Venezuela [ 34 , 35 ]. Roraima is one of the most isolated Brazilian states, being connected by land only to the state of Amazonas.…”

Homogenous HIV-1 subtype B from the Brazilian Amazon with infrequent diverse BF1 recombinants, subtypes F1 and C among blood donors

“…In the North region subtype C was first described in 2012 among blood donors from Amazonas and it has been shown to circulate at low proportions in other states from the North region ranging from 1% in Amapá to 9% in Tocantins [5, 17, 23–26]. Subtype C epidemic was introduced by a single founder strain from East Africa into Southern Brazil and from there it has disseminated throughout the country originating the major C BR clade [43].…”