Surveillance of HIV drug resistance transmission in Iran: experience gained from a pilot study.
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.
Mousavi
Seyed Mohsen
SM
Department of Community Medicine, Faculty of Medicine, Tabriz University of Medical Sciences, Golgasht Ave., Tabriz, Iran. smmousavi@yahoo.com
Hamkar
Rasool
R
Gouya
Mohammad Mehdi
MM
Safaie
Afshin
A
Zahraei
Seyed Mohsen
SM
Yazdani
Zinab
Z
Asbaghi Namini
Somayeh
S
Bertagnolio
Silvia
S
Sutherland
Donald
D
Sandstrom
Paul
P
Brooks
James
J
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
D019380:Anti-HIV Agents; D054303:HIV Reverse Transcriptase; D016333:HIV Protease