title: High frequency of antiviral drug resistance and non-B subtypes in HIV-1 patients failing antiviral therapy in Cuba.
abstract: BACKGROUND
  Emergence of HIV-1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options.
  
  
  OBJECTIVE
  Surveillance of drug resistance and subtypes in HIV-1 patients failing ART in Cuba.
  
  
  METHODS
  This study compiled data of ART-experienced HIV-1 patients attending a clinical center in Havana in 2003 and 2009-2011. The first period included results of a cross-sectional study, whereas in the second period genotyping was performed as part of routine care. Drug resistance mutations and levels were determined using HIVdb version 6.0.9.
  
  
  RESULTS
  Seventy-six percent received solely ART containing at least 3 drugs, of which 79.1% ever receiving unboosted protease inhibitors (PI). Patients from 2009 to 2011 were longer treated and exposed to more ART regimens. Subtype B (39%) and CRF19_cpx (18%) were the most prevalent genetic forms. Subtype distribution did not change significantly between both periods, except for BG recombinants that increased from 6% to 14%. Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside RTI (NNRTI) and PI mutations were present in 69.5%, 54.8% and 44.4%. Full-class resistance (FCR) to NRTI, NNRTI, PI and multidrug resistance (MDR) were detected in 31.8%, 37.9%, 18.5% and 15.4%. FCR to NRTI, NNRTI, PI and MDR were present in 9.8%, 14.1%, 0%, 0% after first-line failure and in 19.8%, 20.8%, 2.9% and 2.9% after second-line failure.
  
  
  CONCLUSIONS
  Our study found a high prevalence of drug resistance and supports the need for appropriate laboratory monitoring in clinical practice and access to drug options in case of virological failure.
authors.affiliation: Virology Department, Institute of Tropical Medicine Pedro Kourí, Autopista Novia del Mediodía Km 6, Marianao 13, Havana City, Cuba. vkouri@ipk.sld.cu
authors.forename: Vivian
authors.initials: V
authors.lastname: Kourí
authors.forename: Yoan
authors.initials: Y
authors.lastname: Alemán
authors.forename: Lissette
authors.initials: L
authors.lastname: Pérez
authors.forename: Jorge
authors.initials: J
authors.lastname: Pérez
authors.forename: Carlos
authors.initials: C
authors.lastname: Fonseca
authors.forename: Consuelo
authors.initials: C
authors.lastname: Correa
authors.forename: Carlos
authors.initials: C
authors.lastname: Aragonés
authors.forename: Jorge
authors.initials: J
authors.lastname: Campos
authors.forename: Delmis
authors.initials: D
authors.lastname: Álvarez
authors.forename: Yoeri
authors.initials: Y
authors.lastname: Schrooten
authors.forename: Nathalie
authors.initials: N
authors.lastname: Dekeersmaeker
authors.forename: Stijn
authors.initials: S
authors.lastname: Imbrechts
authors.forename: Gertjan
authors.initials: G
authors.lastname: Beheydt
authors.forename: Lore
authors.initials: L
authors.lastname: Vinken
authors.forename: Daniel
authors.initials: D
authors.lastname: Pérez
authors.forename: Alina
authors.initials: A
authors.lastname: Álvarez
authors.forename: Yudira
authors.initials: Y
authors.lastname: Soto
authors.forename: Anne-Mieke
authors.initials: AM
authors.lastname: Vandamme
authors.forename: Kristel
authors.initials: K
authors.lastname: Van Laethem
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology*; D003462:Cuba / Q000453:epidemiology; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology* / Q000821:virology*; D015497:HIV-1 / Q000145:classification* / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D017720:Molecular Epidemiology; D015995:Prevalence; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents