title: Antiretroviral drug resistance mutations among treated and treatment-naive patients in Pakistan: diversity of the HIV type 1 pol gene in Pakistan.
abstract: Pakistan is experiencing a growing HIV epidemic. Antiretroviral drugs (ARV) have been smuggled into the country and available without prescription since the early 1990s, but are now provided free of cost by the government. We assessed the prevalence of HIV-1, drug resistance, and subtype distributions. Blood specimens were collected from HIV-1-infected participants registered in Sindh Province on dry blood spot (DBS) cards in 2008. Pol, protease, and partial reverse transcriptase regions were sequenced after reverse transcriptase PCR (RT-PCR). HIV-1 subtype was assigned by phylogenetic analysis. Primary drug resistance was analyzed by the Calibrated Population Resistance (CPR) tool using the Stanford Surveillance Drug Resistance Mutation (SDRM) major mutation list. Out of 100 blood samples collected, 42 were suitable for testing. Out of 42, 11 were ARV-receiving and 31 ARV-naive patients. Among them, 24 were injection drug users (IDUs), four immigrants, two hijras (male transvestites), two men who have sex with men (MSM), four prisoners, one female sex workers, two spouses of HIV-infected persons, and four from the general population. ARV resistance among naive patients was 2/31 (6.5%) and 36.4% (4/11) among ARV-experienced patients making an overall resistance of 14.2%. HIV-1 subtype A1 was the predominant subtype found in 35/42 (83.3%) followed by CRF35_AD and C, 6.5% each. Subtype D and G were found in one (2.4%) each. A significant proportion of Pakistani HIV patients has ARV drug resistance. Physicians treating patients should consider the magnitude of drug resistance while selecting regimens, and address drug adherence aggressively.
authors: Dow University of Health Science, Karachi, Pakistan.
authors: Sharaf
authors: S
authors: Shah
authors: Hui
authors: H
authors: Xing
authors: Arshad
authors: A
authors: Altaf
authors: Bing
authors: B
authors: Chen
authors: Lingjie
authors: L
authors: Liao
authors: Yujiang
authors: Y
authors: Jia
authors: Sten H
authors: SH
authors: Vermund
authors: Yiming
authors: Y
authors: Shao
references: AIDS Res Hum Retroviruses. 2007 Aug;23(8):1062-5
references: 17725425
references: Indian J Med Res. 2000 Jun;111:189-94
references: 10969485
references: J Coll Physicians Surg Pak. 2005 Jun;15(6):378
references: 15924851
references: Int J STD AIDS. 2004 Mar;15(3):209
references: 15038874
references: Virus Res. 2005 Dec;114(1-2):149-53
references: 16054722
references: J Pak Med Assoc. 2009 Mar;59(3):136-40
references: 19288936
references: AIDS Res Hum Retroviruses. 2007 Jun;23(6):834-9
references: 17604548
references: J Pak Med Assoc. 2008 Aug;58(8):419-20
references: 18822635
references: AIDS Res Hum Retroviruses. 2007 Apr;23(4):489-97
references: 17506605
references: Antiviral Res. 2010 Jan;85(1):245-65
references: 19808056
references: BMC Infect Dis. 2006 Nov 14;6:164
references: 17105667
references: J Antimicrob Chemother. 2008 Jun;61(6):1217-20
references: 18344550
references: Evid Rep Technol Assess (Full Rep). 2007 Sep;(156):1-74
references: 18088163
references: N Engl J Med. 2008 Apr 10;358(15):1590-602
references: 18403767
references: AIDS Res Hum Retroviruses. 2007 Oct;23(10):1303-8
references: 17961120
references: J Acquir Immune Defic Syndr. 2003 Sep;34 Suppl 1:S95-100
references: 14562865
references: Int J STD AIDS. 1999 Dec;10(12):812-4
references: 10639063