HIV pretreatment drug resistance trends in three geographic areas of Mexico

García-Morales, Claudia; Tapia-Trejo, Daniela; Quiroz-Morales, Verónica S; Navarro-Álvarez, Samuel; Barrera-Arellano, Carlos A; Casillas-Rodríguez, Jesús; Romero-Mora, Karla; Gómez-Palacio-Schjetnan, María; Murakami-Ogasawara, Akio; Ávila‐Ríos, Santiago; Reyes‐Terán, Gustavo

doi:10.1093/jac/dkx281

Cited by 11 publications

(11 citation statements)

References 31 publications

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“…In the Mexican context, two nationally representative surveys have shown efavirenz/ nevirapine PDR levels close to 10% [8,9]. In addition, a study by our group demonstrated significant increases in efavirenz/nevirapine PDR levels in different areas of the country from 2008 to 2016, including Mexico City [10]. These results, together with advocacy and stewardship efforts, led to a change in national policy to recommend and procure ART regimens containing second-generation integrase strand-transfer inhibitors (INSTI), mainly bictegravir, as preferred first-line options since 2019 [11].…”

Section: Introductionmentioning

confidence: 54%

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

García-Morales¹,

Tapia-Trejo²,

Matías-Florentino³

et al. 2021

Pathogens

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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.

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Section: Introductionmentioning

confidence: 54%

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

García-Morales¹,

Tapia-Trejo²,

Matías-Florentino³

et al. 2021

Pathogens

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“…HIVDR testing was performed on specimens with VL ≥1000 copies/mL according to the WHO/HIV ResNet Laboratory Operational Framework . Briefly, HIV protease and reverse transcriptase were amplified from plasma virus, using an in‐house‐validated protocol (HXB2: 2243 to 3304) and sequences were obtained on a 3730xl Genetic Analyser (ThermoFisher, Waltham, MA) . Integrase (IN) was amplified and sequenced separately, using an in‐house‐validated protocol (HXB2: 4013 to 5265) .…”

Section: Methodsmentioning

confidence: 99%

High levels of pretreatment and acquired HIV drug resistance in Nicaragua: results from the first nationally representative survey, 2016

Girón-Callejas

García-Morales²,

Mendizabal‐Burastero

et al. 2019

J Intern AIDS Soc

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Introduction A nationally representative HIV drug resistance (HIVDR) survey in Nicaragua was conducted to estimate the prevalence of pretreatment HIVDR (PDR) among antiretroviral therapy (ART) initiators and acquired HIVDR among people living with HIV (PLHIV) who had received ART for 12 ± 3 months (ADR12) and ≥48 months (ADR48). Methods A nationwide cross‐sectional survey with a two‐stage cluster sampling was conducted from March to November 2016. Nineteen of 45 total ART clinics representing >90% of the national cohort of adults on ART were included. ART initiators were defined as PLHIV initiating or reinitiating first‐line ART. HIVDR was assessed for protease, reverse transcriptase and integrase Sanger sequences using the Stanford HIVdb algorithm. Viral load (VL) suppression was defined as <1000 copies/mL. Results were weighted according to the survey design. Results and discussion A total of 638 participants were enrolled (PDR: 171; ADR12: 114; ADR48: 353). The proportion of ART initiators with prior exposure to antiretrovirals (ARVs) was 12.3% (95% CI: 5.8% to 24.3%). PDR prevalence to any drug was 23.4% (95% CI: 14.4% to 35.6%), and 19.3% (95% CI: 12.2% to 29.1%) to non‐nucleoside reverse transcriptase inhibitors (NNRTI). NNRTI PDR was higher in ART initiators with previous ARV exposure compared with those with no exposure (76.2% vs. 11.0%, p < 0.001). Protease inhibitors (PI) and integrase strand transfer inhibitors PDR was not observed. VL suppression rate was 77.8% (95% CI: 67.1% to 85.8%) in ADR12 and 70.3% (95% CI: 66.7% to 73.8%) in ADR48. ADR12 prevalence to any drug among PLHIV without VL suppression was 85.1% (95% CI: 66.1% to 94.4%), 82.4% to NNRTI and 70.2% to nucleoside reverse transcriptase inhibitors (NRTI). ADR48 prevalence to any drug among PLHIV without VL suppression was 75.5% (95% CI: 63.5% to 84.5 %), 70.7% to NNRTI, 59.4% to NRTI and 4.6% to PI. Conclusions Despite implementation challenges yielding low‐precision HIVDR estimates, high rates of NNRTI PDR were observed in Nicaragua, suggesting consideration of non‐NNRTI‐based first‐line regimens for ART initiators. Strengthened HIVDR monitoring, systematic VL testing, and improved ART adherence support are also warranted.

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“…Our data set was compiled using all available HIV subtype B partial pol sequences, the predominant circulating subtype in the United States and Mexico [19,20] and samples obtained in convenience based efforts from participants enrolled in (i) the San Diego Primary Infection Resource Consortium (SD PIRC) from 1996 to 2018 and (ii) in Tijuana as part of the Mexican HIV Drug Resistance Surveillance Network studies (76%) [10,21], the Enlaces and El Cuete research studies (24%) [22]…”

Section: Compilation Of Data Sets For Phylogenetic Inferencementioning

confidence: 99%

“…The HIV epidemic in the San Diego-Tijuana border region is complex. In contrast to other parts of Mexico and the United States that have epidemics in which the major risk group are men who have sex with men (MSM), the HIV epidemic along the border is more distributed among risk populations, including MSM, persons who inject drugs (PWID), persons who have transactional sex, and Mexican and Central American migrants [5][6][7][8][9][10]. Hence, the San Diego-Tijuana border region is at the crossroad of multiple risk groups, which leads to transmissions between risk groups [11], possibly enhancing the spread of HIV [12].…”

Section: Introductionmentioning

confidence: 99%

Dynamics and Dispersal of Local Human Immunodeficiency Virus Epidemics Within San Diego and Across the San Diego–Tijuana Border

Vrancken

Mehta

Ávila‐Ríos³

et al. 2020

Clinical Infectious Diseases

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Background Evolutionary analyses of well-annotated HIV sequence data can provide insights into viral transmission patterns and associated factors. Here, we explored the transmission dynamics of the HIV-1 subtype B epidemic across the San Diego (US) – Tijuana (Mexico) border region to identify factors that could help guide public health policy. Methods HIV pol sequences were collected from people with HIV in San Diego County and from Tijuana between 1996-2018. A multistep phylogenetic approach was used to characterize the dynamics of spread. The contribution of geospatial factors and HIV risk group to the local dynamics were evaluated. Results Phylogeographic analyses of the 2,034 sequences revealed an important contribution of local transmission in sustaining the epidemic, as well as a complex viral migration network across the region. Geospatial viral dispersal between San Diego communities occurred predominantly among men-who-have-sex with-men with central San Diego being the main source (34.9%) and recipient (39.5%) of migration events. HIV migration was more frequent from San Diego county towards Tijuana than vice versa. Migrations were best explained by driving time between locations. Conclusion The US-Mexico border may not be a major barrier to the spread of HIV, which may stimulate coordinated transnational intervention approaches. Whereas a focus on central San Diego has the potential to avert most spread, the substantial viral migration independent of central San Diego shows that county-wide efforts will be more effective. Combined, this work shows that epidemiological information gleaned from pathogen genomes can uncover mechanisms that underlie sustained spread and, in turn, can be a building block of public health decision making.

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HIV pretreatment drug resistance trends in three geographic areas of Mexico

Cited by 11 publications

References 31 publications

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

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

High levels of pretreatment and acquired HIV drug resistance in Nicaragua: results from the first nationally representative survey, 2016

Dynamics and Dispersal of Local Human Immunodeficiency Virus Epidemics Within San Diego and Across the San Diego–Tijuana Border

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