title: HIV type 1 subtype C drug resistance among pediatric and adult South African patients failing antiretroviral therapy.
abstract: The emergence of HIV drug resistance is a major obstacle to effective antiretroviral (ARV) treatments. This study examined the drug resistance profiles among South African patients virologically failing ARV therapies between 2000 and 2003, prior to the introduction of a national treatment program. Samples were obtained from 65 HIV-1 subtype C-infected patients (39 children and 26 adults) who had received at least two nucleoside reverse transcriptase inhibitors (NRTIs) and either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or protease inhibitor (PI). Resistance assays were performed using the HIV-1 ViroSeq Genotyping System and mutations were defined according to the Stanford Sequence Resistance Database. Ninety-one percent of patients harbored resistance mutations; the most frequent NRTI mutations were M184V/I (37%), D67N (32%), T215Y/F (25%), K70R (21%), M41L (20%), K219Q/E (14%), and K65R (14%), reflecting the frequent use of lamuvidine and zidovudine. K103N (25%), V106M (20%), and G190A (17%) were found among patients failing nevirapine- or efavirenz-containing regimens. Of the patients who received PIs, the most common mutations were V82A/T (12%), M46I (11%), and L90M (8%). Mutations were similar among adults and children. These data indicate that HIV-1 drug resistance develops in South African subtype C-infected patients failing ARV therapy with mutations comparable to those found among patients infected with subtype B viruses.
authors.affiliation: National Institute for Communicable Diseases, AIDS Virus Research Unit, Johannesburg, South Africa.
authors.forename: Visva
authors.initials: V
authors.lastname: Pillay
authors.forename: Candice
authors.initials: C
authors.lastname: Pillay
authors.forename: Rami
authors.initials: R
authors.lastname: Kantor
authors.forename: Francois
authors.initials: F
authors.lastname: Venter
authors.forename: Leon
authors.initials: L
authors.lastname: Levin
authors.forename: Lynn
authors.initials: L
authors.lastname: Morris
mesh_terms: D000293:Adolescent; D000328:Adult; D019943:Amino Acid Substitution / Q000235:genetics; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D002648:Child; D002675:Child, Preschool; D016000:Cluster Analysis; D024882:Drug Resistance, Viral; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D008875:Middle Aged; D020125:Mutation, Missense; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D013019:South Africa; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents