Transmitted Drug Resistance among People Living with HIV/Aids at Major Cities of Sao Paulo State, Brazil

Abstract

Human immunodeficiency virus type 1 (HIV-1) transmitted drug resistance (TDR) is an important public health issue. In Brazil, low to intermediate resistance levels have been described. We assessed 225 HIV-1 infected, antiretroviral naïve individuals, from HIV Reference Centers at two major metropolitan areas of Sao Paulo (Sao Paulo and Campinas), the state that concentrates most of the Brazilian Aids cases. TDR was analyzed by Stanford Calibrated Population Resistance criteria (CPR), and mutations were observed in 17 individuals (7.6%, 95% CI: 4.5%–11.9%). Seventy-six percent of genomes (13/17) with TDR carried a nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance mutation, mostly K103N/S (9/13, 69%), potentially compromising the preferential first-line therapy suggested by the Brazilian HIV Treatment Guideline that recommends efavirenz-based combinations. Moreover, 6/17 (35%) had multiple mutations associated with resistance to one or more classes. HIV-1 B was the prevalent subtype (80%); other subtypes include HIV-1 F and C, mosaics BC, BF, and single cases of subtype A1 and CRF02_AG. The HIV Reference Center of Campinas presented more cases with TDR, with a significant association of TDR with clade B infection (P < 0.05).

HIV-1 transmitted drug resistance and genetic diversity among patients from Piauí State, Northeast Brazil

“…The overall moderate rate of TDR identified in the current study (11.2%) is in accordance with reports from other geographical regions in Brazil: 11.5% in the Northern Tocantins State; 10% in the Central Western Goiás State; 14.2% in the Southeastern São Paulo State, and 11% in the Southern Santa Catarina State [Cardoso et al, ; Carvalho et al, ; Graf et al, ; Ferreira et al, ]. Two recent multicenter surveys in Brazil have shown moderate levels of TDR [Inocencio et al, ; Sprinz et al, ].…”

“…The Brazilian AIDS epidemic is highly concentrated in the Southeast and South regions and several studies from these regions have reported TDR levels in different study groups [Inocencio et al, ; Sprinz et al, ; Sanabani et al, ; Ferreira et al, ; Pilotto et al, ; UNAIDS, ]. However, there is scanty data on the HIV‐1 molecular epidemiology in other regions away from the epicenter of the epidemics.…”

High rates of baseline antiretroviral resistance among HIV-infected pregnant women in an HIV referral centre in Rio de Janeiro, Brazil

“…These two mutations have been well characterised in the HIV-infected Brazilian population and are likely associated with the early high use of nevirapine based cART regimens for PMTCT purposes in southeastern and southern Brazil, from 1998 to 2001. [18][19][20] Although the Stanford algorithm employed in this study for characterisation of resistant mutations among ARV-naı¨ve subjects might tend to overestimate resistance, removal of questionable resistance mutations from the analysis did not change the number of naı¨ve subjects harbouring resistance to any class of ARVs. The moderate prevalence of ARV-resistance coupled with the high frequency of the aforementioned mutations which abrogate many commonly employed treatment plans, enforce the necessity to promote routine and universal ARV susceptibility testing to all Brazilian HIV-infected pregnant women for PMTCT purposes.…”

Low Rate of Transmitted Drug Resistance May Indicate Low Access to Antiretroviral Treatment in Maranhão State, Northeast Brazil

“…3 Low to moderate levels of TDR have been reported in patients from the most densely populated southeast/south regions in Brazil. [4][5][6][7] However, there are very limited data from regions where the epidemic is growing, including Maranhão State in northeast Brazil, our study area, which has recently reported a 106.2% increase in AIDS cases rate. This is the first detailed molecular epidemiological investigation of TDR and HIV-1 genetic diversity among ARV-naive patients from Maranhão.…”