title: Analysis of HIV-1 protease gene reveals frequent multiple infections followed by recombination among drug treated individuals living in São Paulo and Santos, Brazil.
abstract: The present study investigated the prevalence of HIV-1 multiple infections in a population composed by 47 patients under HAART failure and enrolled at the National DST/AIDS, Program, Ministry of Health, Brazil.Detection of multiple infections was done using a previously published RFLP assay for the HIV-1 protease gene, which is able of distinguishing between infections caused by a single or multiple HIV-1 subtypes. Samples with multiple infections were cloned, and sequence data submitted to phylogenetic analysis. We were able to identify 17 HIV-1 multiple infections out of 47 samples. Multiple infections were mostly composed by a mixture of recombinant viruses (94%), with only one case in which protease gene pure subtypes B and F were recovered. This is the first study that reports the prevalence of multiple infections and intersubtype recombinants in a population undergoing HAART in Brazil. Based on the data there was a steep increase of multiple infections after the introduction of the combined antiretroviral therapy in Brazil. Cases of multiple infections may be associated with HIV-1 genetic diversity through recombination allowing for the generation of viruses showing a combination of resistance mutations.
authors.affiliation: Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Edsel Renata De Morais
authors.initials: ER
authors.lastname: Nunes
authors.affiliation: Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Jean Paulo
authors.initials: JP
authors.lastname: Zukurov
authors.affiliation: Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Juliana Terzi
authors.initials: JT
authors.lastname: Maricato
authors.affiliation: Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Maria Cecília Araripe
authors.initials: MC
authors.lastname: Sucupira
authors.affiliation: Department of Medicine, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Ricardo Sobhie
authors.initials: RS
authors.lastname: Diaz
authors.affiliation: Department of Medicine, Federal University of São Paulo, São Paulo, Brazil ; Department of Microbiology, Immunology and Parasitology, Federal University of São Paulo, São Paulo, Brazil.
authors.forename: Luíz Mário Ramos
authors.initials: LM
authors.lastname: Janini
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology; D001938:Brazil; D024882:Drug Resistance, Viral; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology*; D016333:HIV Protease / Q000235:genetics*; D015497:HIV-1 / Q000145:classification / Q000235:genetics*; D006801:Humans; D008969:Molecular Sequence Data; D010802:Phylogeny; D016865:Reassortant Viruses / Q000145:classification / Q000235:genetics; D011995:Recombination, Genetic
chemical_list: D019380:Anti-HIV Agents; D016333:HIV Protease