title: Characterization of the patterns of drug-resistance mutations in newly diagnosed HIV-1 infected patients naïve to the antiretroviral drugs.
abstract: BACKGROUND
  The transmission of HIV-1 drug-resistant strains in drug naive patients may seriously compromise the efficacy of a first-line antiretroviral treatment. To better define this problem, a study in a cohort of newly diagnosed HIV-1 infected individuals has been conducted. This study is aimed to assess the prevalence and the patterns of the mutations recently associated with transmitted drug resistance in the reverse transcriptase (RT) and in protease (PR) of HIV-1.
  
  
  METHODS
  Prevalence of transmitted drug resistant strains is determined in 255 newly diagnosed HIV-1 infected patients enrolled in different counselling and testing (CT) centres in Central Italy; the Avidity Index (AI) on the first available serum sample is also used to estimate time since infection. Logistic regression models are used to determine factors associated with infection by drug resistant HIV-1 strains.
  
  
  RESULTS
  The prevalence of HIV-1 strains with at least one major drug resistance mutation is 5.9% (15/255); moreover, 3.9% (10/255) of patients is infected with HIV nucleoside reverse transcriptase inhibitor (NRTI)-resistant viruses, 3.5% (9/255) with HIV non-NRTI-resistant viruses and 0.4% (1/255) with HIV protease inhibitor (PI)-resistant viruses. Most importantly, almost half (60.0%) of patients carries HIV-1 resistant strains with more than one major drug resistance mutation. In addition, patients who had acquired HIV through homosexual intercourses are more likely to harbour a virus with at least one primary resistance mutation (OR 7.7; 95% CI: 1.7-35.0, P = 0.008).
  
  
  CONCLUSIONS
  The prevalence of drug resistant HIV-1 strains among newly diagnosed individuals in Central Italy is consistent with the data from other European countries. Nevertheless, the presence of drug-resistance HIV-1 mutations in complex patterns highlights an additional potential risk for public health and strongly supports the extension of wide genotyping to newly diagnosed HIV-1 infected patients.
authors.affiliation: Department of Experimental Medicine and Biochemical Sciences, University of Tor Vergata Rome, Italy. claudia.alteri@uniroma2.it
authors.forename: Claudia
authors.initials: C
authors.lastname: Alteri
authors.forename: Valentina
authors.initials: V
authors.lastname: Svicher
authors.forename: Caterina
authors.initials: C
authors.lastname: Gori
authors.forename: Roberta
authors.initials: R
authors.lastname: D'Arrigo
authors.forename: Massimo
authors.initials: M
authors.lastname: Ciccozzi
authors.forename: Francesca
authors.initials: F
authors.lastname: Ceccherini-Silberstein
authors.forename: Marina
authors.initials: M
authors.lastname: Selleri
authors.forename: Stefano Aviani
authors.initials: SA
authors.lastname: Bardacci
authors.forename: Massimo
authors.initials: M
authors.lastname: Giuliani
authors.forename: Paola
authors.initials: P
authors.lastname: Elia
authors.forename: Paola
authors.initials: P
authors.lastname: Scognamiglio
authors.forename: Roberta
authors.initials: R
authors.lastname: Balzano
authors.forename: Nicoletta
authors.initials: N
authors.lastname: Orchi
authors.forename: Enrico
authors.initials: E
authors.lastname: Girardi
authors.forename: Carlo Federico
authors.initials: CF
authors.lastname: Perno
mesh_terms: D000328:Adult; D015331:Cohort Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D019143:Evolution, Molecular; D005260:Female; D015483:HIV Antibodies / Q000097:blood; D015658:HIV Infections / Q000188:drug therapy*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009154:Mutation; D010802:Phylogeny; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D016415:Sequence Alignment
chemical_list: D015483:HIV Antibodies; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors