title: Transmitted drug resistance among antiretroviral-naive patients with established HIV type 1 infection in Santo Domingo, Dominican Republic and review of the Latin American and Caribbean literature.
abstract: Emergence of HIV resistance is a concerning consequence of global scale-up of antiretroviral therapy (ART). To date, there is no published information about HIV resistance from the Dominican Republic. The study's aim was to determine the prevalence of transmitted drug resistance (TDR) to reverse transcriptase and protease inhibitors in a sample of chronically HIV-1-infected patients in one clinic in Santo Domingo. The data are presented in the context of a review of the TDR literature from Latin America and the Caribbean. Genotype testing was successfully performed on 103 treatment-naive adults planning to initiate antiretroviral therapy; the World Health Organization (WHO) list of surveillance drug resistance mutations (SDRM) was used to determine the presence of TDR mutations. WHO SDRM were identified in eight patients (7.8%); none had received sdNVP. There were no significant differences in epidemiologic or clinical variables between those with or without WHO SDRM. The prevalence of WHO SDRM was 1.0% and 6.8% for nucleoside reverse transcriptase inhibitors and nonnucleoside reverse transcriptase inhibitors, respectively. No WHO SDRMs for protease inhibitors were identified. Among 12 studies of TDR in the region with a sample size of at least 100 subjects, the reported prevalence of SDRM ranged from 2.8% to 8.1%. The most commonly identified SDRM was K103N. This information adds to our understanding of the epidemiology of TDR in the region and the possible role such mutations could play in undermining first-line treatment. Ongoing surveillance is clearly needed to better understand the TDR phenomenon in the Caribbean.
authors.affiliation: Division of Infectious Diseases, Columbia University Medical Center, New York, NY 10032, USA. jem2200@columbia.edu
authors.forename: Julie E
authors.initials: JE
authors.lastname: Myers
authors.forename: Barbara S
authors.initials: BS
authors.lastname: Taylor
authors.forename: Rita A
authors.initials: RA
authors.lastname: Rojas Fermín
authors.forename: Emily Virginia
authors.initials: EV
authors.lastname: Reyes
authors.forename: Catherine
authors.initials: C
authors.lastname: Vaughan
authors.forename: Lina
authors.initials: L
authors.lastname: José
authors.forename: Carmen
authors.initials: C
authors.lastname: Javier
authors.forename: Ramona
authors.initials: R
authors.lastname: Franco Estévez
authors.forename: Yeycy
authors.initials: Y
authors.lastname: Donastorg Cabral
authors.forename: Arelis
authors.initials: A
authors.lastname: Batista
authors.forename: Yolanda
authors.initials: Y
authors.lastname: Lie
authors.forename: Eoin
authors.initials: E
authors.lastname: Coakley
authors.forename: Scott M
authors.initials: SM
authors.lastname: Hammer
authors.forename: Karen
authors.initials: K
authors.lastname: Brudney
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology*; D017691:Caribbean Region; D004293:Dominican Republic / Q000453:epidemiology; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D017320:HIV Protease Inhibitors / Q000494:pharmacology*; D054303:HIV Reverse Transcriptase / Q000494:pharmacology*; D006679:HIV Seropositivity / Q000188:drug therapy / Q000453:epidemiology* / Q000235:genetics*; D015497:HIV-1 / Q000235:genetics* / Q000302:isolation & purification; D006297:Health Services Accessibility; D006801:Humans; D007843:Latin America; D008297:Male; D017720:Molecular Epidemiology; D020125:Mutation, Missense; D011159:Population Surveillance; D015995:Prevalence; D012367:RNA, Viral
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D054303:HIV Reverse Transcriptase