title: HIV-1 drug resistance in Thailand: before and after National Access to Antiretroviral Program.
abstract: BACKGROUND
  The Ministry of Public Health (Thailand), MoPH, has had a program called National Access to Antiretroviral Program for People who have AIDS (PHA) or "NAPHA", to offer free antiretroviral drugs (ARV), which are locally produced in Thailand, to any HIV-1 infected patients with CD4<200 since 2002. This program may increase usage of ARV therapy and the emergence of HIV-1 drug resistance.
  
  
  OBJECTIVE
  To monitor HIV-1 ARV drug resistant codon mutation in Thailand before and after the "NAPHA" program.
  
  
  METHODS
  EDTA blood samples were collected from 542 HIV-1 infected subjects, who received ARV therapy in 1999 and 2001-2003, and perinatal chemoprophylaxis in 1998 and 2000. HIV-1 pol nucleotide sequences were analyzed.
  
  
  RESULTS
  The percentage of drug resistant detection from the ARV therapy group in 1999 and 2001-2003 were 12.14 (34/280), 10.23 (9/88), 86.96 (20/23) and 57.55 (61/106), respectively. Of 332 NRTI drug resistant codon mutation, 226 (68.07%) were thymidine analogue mutations (TAMs). The percentage of TAMs detection in 1999 and 2001-2003 were 7.14 (20/280), 9.09 (8/88), 56.52 (13/23) and 43.34 (46/106), respectively. Of 105 NNRTI drug resistant codon mutation, 95 (90.48%) were related to nevirapine drug resistance.
  
  
  CONCLUSIONS
  Thailand may need more appropriate monitoring of drug resistance in the free ARV therapy program to protect the future usage of drugs by minimizing the emergence of drug resistance.
authors.affiliation: National HIV Repository and Bioinformatic Center (Thailand), Department of Microbiology, Faculty of Medicine Siriraj Hospital, Mahidol University, 2 Prannok Road, Bangkok 10700, Thailand. sirst@mahidol.ac.th
authors.forename: Ruengpung
authors.initials: R
authors.lastname: Sutthent
authors.forename: Daungnapa
authors.initials: D
authors.lastname: Arworn
authors.forename: Surapol
authors.initials: S
authors.lastname: Kaoriangudom
authors.forename: Kulkanya
authors.initials: K
authors.lastname: Chokphaibulkit
authors.forename: Pongsakdi
authors.initials: P
authors.lastname: Chaisilwatana
authors.forename: Piyanot
authors.initials: P
authors.lastname: Wirachsilp
authors.forename: Vipa
authors.initials: V
authors.lastname: Thiamchai
authors.forename: Thaweesarp
authors.initials: T
authors.lastname: Sirapraphasiri
authors.forename: Sombat
authors.initials: S
authors.lastname: Tanprasertsuk
mesh_terms: D044966:Anti-Retroviral Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024882:Drug Resistance, Viral / Q000235:genetics*; D015751:Genes, pol; D006078:Government Programs; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006306:Health Surveys; D006801:Humans; D009154:Mutation; D019829:Nevirapine / Q000494:pharmacology; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology; D013785:Thailand; D013936:Thymidine / Q000235:genetics; D016896:Treatment Outcome
chemical_list: D044966:Anti-Retroviral Agents; D018894:Reverse Transcriptase Inhibitors; D019829:Nevirapine; D054303:HIV Reverse Transcriptase; D013936:Thymidine