Prevalence of HIV Drug Resistance Mutations in HIV Type 1 Isolates in Antiretroviral Therapy Naïve Population from Northern India

Abstract

<jats:p><jats:italic>Objective</jats:italic>. The increased use of antiretroviral therapy (ART) has reduced the morbidity and mortality associated with HIV, adversely leading to the emergence of HIV drug resistance (HIVDR). In this study we aim to evaluate the prevalence of HIVDR mutations in ART-naive HIV-1 infected patients from northern India.<jats:italic>Design</jats:italic>. Analysis was performed using Viroseq genotyping system based on sequencing of entire protease and two-thirds of the Reverse Transcriptase (RT) region of<jats:italic>pol</jats:italic>gene.<jats:italic>Results</jats:italic>. Seventy three chronic HIV-1 infected ART naïve patients eligible for first line ART were enrolled from April 2006 to August 2008. In 68 patients DNA was successfully amplified and sequencing was done. 97% of HIV-1 strains belonged to subtype C, and one each to subtype A1 and subtype B. The overall prevalence of primary DRMs was 2.9% [2/68, 95% confidence interval (CI), 0.3%–10.2%]. One patient had a major RT mutation M184V, known to confer resistance to lamivudine, and another had a major protease inhibitor (PI) mutation D30N that imparts resistance to nelfinavir.<jats:italic>Conclusion</jats:italic>. Our study shows that primary HIVDR mutations have a prevalence of 2.9% among ART-naive chronic HIV-1 infected individuals.</jats:p>

Zero prevalence of primary drug resistance-associated mutations to protease inhibitors in HIV-1 drug-naive patients in and around Aligarh, India

“…All the study subjects were found to be infected with HIV subtype C. Other studies also support the dominance of HIV-1 subtype C strains in India [2,10,[16][17][18].…”

“…However, the prevalence of primary HIV-DR in the protease gene has been reported to be 14.2% by Arora et al in 2008 [10] [22], and 4% by Deshpande et al in 2011 [23]. Several secondary drug resistanceassociated mutations were also reported by some of these studies [2,10,[19][20][21][22][23]. The M36I mutation in the protease gene (associated with resistance to ritonavir and nelfinavir in B subtype viruses) [15] was found in 35 (67.3%) strains.…”

“…It has been estimated that approximately 2.31 million people are living with HIV/AIDS in India [2] and nearly 9.7 million people are receiving anti-retroviral therapy (ART) in low-and middle-income countries by the end of 2012 as per UNAIDS global report 2013. ART is the best and only option to reduce morbidity and mortality associated with HIV infection [3].…”

“…Thus, the growing diversity of HIV-1 protease gene sequences in India highlights the need for closer epidemiological characterization of viral isolates prior to the introduction of new PIs. PIs were introduced after 2008 by the Indian government in the ART program of India as second-line treatment regimens [2]. Resistance development may differ according to primary, secondary, or polymorphic mutations [7].…”

Comparative analysis of drug resistance mutations in the human immunodeficiency virus reverse transcriptase gene in patients who are non-responsive, responsive and naive to antiretroviral therapy

“…The current recommended HIV treatment in India includes two nucleoside reverse transcriptase inhibitors (NRTIs) -zidovudine (AZT) or stavudine (d4T) plus lamivudine (3TC) -in combination with one non-nucleoside reverse transcriptase inhibitor (NNRTI) -nevirapine (NVP) or efavirenz (EFV) -as first-line therapy for ARV-naive patients. Protease inhibitors are used in the second-line treatment regimen [3]. The widespread use of ART is reported to be associated with an impressive decline in the morbidity and mortality of HIV-1-infected patients [4,5].…”