title: Surveillance of HIV drug resistance transmission in Iran: experience gained from a pilot study.
abstract: We performed a pilot surveillance study on transmitted HIV drug resistance (TDR) in Iran, with specimens collected and stored as dried blood spots (DBS). The protease region and relevant positions in the reverse transcriptase region of the pol gene were sequenced to detect mutations known to be associated with resistance to drugs in standard first-line regimens. Seventy-three specimens were collected, with 39 (53%) specimens yielding sequence from both protease and at least part of RT. Specimens were almost exclusively HIV-1 subtype CRF 35_A1D based on pol sequencing. Mutations were restricted to RT, with D67DG and V75AV each seen in a single specimen. An atypical protease inhibitor mutation, I47M, appeared at a resistance-associated position in protease from a single specimen. These preliminary data showed that the rate of transmitted drug resistance in Iran, within the areas sampled, was 5.1% (2/39). However, the small sample size makes this figure only an approximation. Due to the sampling strategy and resulting small sample size, we were unable to accurately calculate TDR rates for individual areas using the WHO HIV drug resistance threshold survey method. Increasing the sample size and improving the yield from DBS would improve the accuracy of drug resistance surveillance and facilitate wider application of this methodology in Iran.
authors.affiliation: Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Golgasht Ave., Tabriz, Iran. smmousavi@yahoo.com
authors.forename: Seyed Mohsen
authors.initials: SM
authors.lastname: Mousavi
authors.forename: Rasool
authors.initials: R
authors.lastname: Hamkar
authors.forename: Mohammad Mehdi
authors.initials: MM
authors.lastname: Gouya
authors.forename: Afshin
authors.initials: A
authors.lastname: Safaie
authors.forename: Seyed Mohsen
authors.initials: SM
authors.lastname: Zahraei
authors.forename: Zinab
authors.initials: Z
authors.lastname: Yazdani
authors.forename: Somayeh
authors.initials: S
authors.lastname: Asbaghi Namini
authors.forename: Silvia
authors.initials: S
authors.lastname: Bertagnolio
authors.forename: Donald
authors.initials: D
authors.lastname: Sutherland
authors.forename: Paul
authors.initials: P
authors.lastname: Sandstrom
authors.forename: James
authors.initials: J
authors.lastname: Brooks
mesh_terms: D000293:Adolescent; D000328:Adult; D019943:Amino Acid Substitution / Q000235:genetics; D019380:Anti-HIV Agents / Q000494:pharmacology*; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000635:transmission* / Q000821:virology*; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000145:classification / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007492:Iran; D008297:Male; D020125:Mutation, Missense; D010802:Phylogeny; D010865:Pilot Projects; D017422:Sequence Analysis, DNA; D017385:Sequence Homology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D054303:HIV Reverse Transcriptase; D016333:HIV Protease