title: HIV-1 pol phylogenetic diversity and antiretroviral resistance mutations in treatment naïve patients from Central West Brazil.
abstract: BACKGROUND
  Primary resistance represents a challenge for the control of HIV-1 because it can reduce the efficacy of first line antiretroviral therapy and may impact clinical outcomes.
  
  
  OBJECTIVE
  To describe the prevalence of primary HIV-1 drug resistance and subtypes circulating in Central West Brazil.
  
  
  METHODS
  103 antiretroviral naïve patients were recruited in Goiânia city, Central West Brazil during 2007-2008. Protease and partial reverse transcriptase regions were retrotranscribed from plasma HIV-1 RNA and 97 were sequenced after direct nested PCR. HIV-1 subtype was assigned by phylogenetic analysis. Primary drug resistance was analyzed by the Calibrated Population Resistance (CPR) tool using Stanford Surveillance Drug Resistance Mutation (SDRM) and International AIDS Society-USA (IAS-USA) major mutation list.
  
  
  RESULTS
  Primary drug resistance mutations ranged from 8% (IAS) to 10% (SDRM). High level resistance to at least one antiretroviral drug was observed. T215D/S revertant mutations were identified in 4/97 patients. HIV-1 subtype B represented 82.5%, subtype F1 6.2%, subtype C 3.1%, B/F1 7.2% and one sample was a F1/C/B mosaic. HIV-1 subtype C sequences formed a monophyletic cluster with other Brazilian subtype C sequences.
  
  
  CONCLUSIONS
  Our HIV-1 pol sequences from Central West region include the first inland HIV-1 subtype C sequences and help compose the molecular epidemiology map of HIV-1 in Brazil. This data also show that a significant proportion of the naïve patients presented important drug resistance mutations. Therefore naive patients from this setting may benefit from pre-treatment genotypic testing to optimize the choice of antiretroviral drugs and to help control HIV-1 transmission.
authors.affiliation: Tropical Pathology and Public Health Institute, Federal University of Goiás, Goiânia/Goiás, Brazil.
authors.forename: Ludimila Paula Vaz
authors.initials: LP
authors.lastname: Cardoso
authors.forename: Boaventura Braz de
authors.initials: BB
authors.lastname: Queiroz
authors.forename: Mariane Martins de Araújo
authors.initials: MM
authors.lastname: Stefani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D019943:Amino Acid Substitution; D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D001938:Brazil / Q000453:epidemiology; D002675:Child, Preschool; D003627:Data Interpretation, Statistical; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D009154:Mutation; D010802:Phylogeny; D012367:RNA, Viral / Q000097:blood; D020133:Reverse Transcriptase Polymerase Chain Reaction; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics*
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral; D054302:pol Gene Products, Human Immunodeficiency Virus; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase; D016333:HIV Protease