title: Antiretroviral drug resistance among antiretroviral-naïve and treatment experienced patients infected with HIV in Iran.
abstract: Resistance to antiretroviral therapy (ART) threatens the success of programs to reduce HIV morbidity and mortality, particularly in countries with few treatment options. In the present study, genotype and phenotype data from ART-naïve and experienced hospitalized patients infected with HIV in Tehran, Iran were used to assess the prevalence and types of transmitted (TDR) and acquired drug resistance (ADR) mutations. All 30 participants naïve to ART and 62 of 70 (88.6%) participants receiving ART had detectable viral loads. Among participants receiving ART with sequencing data available (n = 62), 36 (58.1%) had at least one drug resistance mutation; the most common mutations were K103N (21.0%), M184V (19.4%), and the thymidine analogue mutations. Seven (11.3%), 27 (43.5%), and two (3.2%) of these participants had resistance to one, two, and three drug classes, respectively. High-level resistance to efavirenz (EFV) was more common among participants on EFV-based regimens than high-level lopinavir/ritonivar (LPV/r) resistance among those on LPV/r-based regimens (55.3% vs. 6.7%, P < 0.0001). Two (6.7%) antiretroviral-naïve participants had K103N mutations. These findings document an alarmingly high frequency of multiple HIV drug class resistance in Iran, confirm the presence of TDR, and highlight the need for systematic viral load monitoring and drug resistance testing, including at diagnosis. Expanded access to new antiretroviral medications from additional drug classes is needed.
authors.affiliation: Iranian Research Center for HIV/AIDS, Iranian Institute for Reduction of High Risk Behaviors, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Kazem
authors.initials: K
authors.lastname: Baesi
authors.forename: Mehrdad
authors.initials: M
authors.lastname: Ravanshad
authors.forename: Maryam
authors.initials: M
authors.lastname: Ghanbarisafari
authors.forename: Esmaeil
authors.initials: E
authors.lastname: Saberfar
authors.forename: Seyedahmad
authors.initials: S
authors.lastname: Seyedalinaghi
authors.forename: Jonathan E
authors.initials: JE
authors.lastname: Volk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019380:Anti-HIV Agents / Q000627:therapeutic use; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000187:drug effects* / Q000302:isolation & purification; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D020125:Mutation, Missense; D015995:Prevalence; D012367:RNA, Viral / Q000235:genetics; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral
keywords: HIV; Iran; acquired drug resistance; drug resistance; transmitted drug resistance