title: Transmitted HIV drug resistance in antiretroviral-treatment-naive patients from Poland differs by transmission category and subtype.
abstract: OBJECTIVE
  The surveillance of HIV-transmitted drug resistance mutations (t-DRMs), including temporal trends across subtypes and exposure groups, remains a priority in the current management of the epidemic worldwide.
  
  
  METHODS
  A cross-sectional analysis of 833 treatment-naive patients from 9 of 17 Polish HIV treatment centres. Partial pol sequences were used to analyse drug resistance with a general time reversible (GTR)-based maximum likelihood algorithm used for cluster/pair identification. Mutation frequencies and temporal trends were investigated.
  
  
  RESULTS
  t-DRMs were observed in 9% of cases (5.8% for NRTI, 1.2% NNRTI and 2.0% PI mutations) and were more common among heterosexually infected (HET) individuals (13.4%) compared with MSM (8.3%, P = 0.03) or injection drug users (IDUs; 2.9%, P = 0.001) and in MSM compared with IDUs (P = 0.046). t-DRMs were more frequent in cases infected with the non-B variant (21.6%) compared with subtype B (6.6%, P < 0.001). With subtype B a higher mutation frequency was found in MSM compared with non-MSM cases (8.3% versus 1.8% for IDU + HET, P = 0.038), while non-B variants were associated with heterosexual exposure (30.4% for HET versus 4.8% for MSM, P = 0.019; versus 0 for IDU, P = 0.016). Trends in t-DRM frequencies were stable over time except for a decrease in NNRTI t-DRMs among MSM (P = 0.0662) and an NRTI t-DRM decrease in HET individuals (P = 0.077). With subtype B a higher frequency of sequence pairs/clusters in MSM (50.4%) was found compared with HET (P < 0.001) and IDUs (P = 0.015).
  
  
  CONCLUSIONS
  Despite stable trends over time, patterns of t-DRMs differed notably between transmission categories and subtypes: subtype B was associated with MSM transmission and clustering while in non-B clades t-DRMs were more common and were associated with heterosexual infections.
authors.affiliation: Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Arkońska 4, Szczecin, Poland mparczewski@yahoo.co.uk.
authors.forename: Miłosz
authors.initials: M
authors.lastname: Parczewski
authors.affiliation: Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Arkońska 4, Szczecin, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Leszczyszyn-Pynka
authors.affiliation: Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Arkońska 4, Szczecin, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Witak-Jędra
authors.affiliation: Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Arkońska 4, Szczecin, Poland.
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Maciejewska
authors.affiliation: Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Koszarowa 5, Wrocław, Poland.
authors.forename: Weronika
authors.initials: W
authors.lastname: Rymer
authors.affiliation: Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Koszarowa 5, Wrocław, Poland.
authors.forename: Aleksandra
authors.initials: A
authors.lastname: Szymczak
authors.affiliation: Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Koszarowa 5, Wrocław, Poland.
authors.forename: Bartosz
authors.initials: B
authors.lastname: Szetela
authors.affiliation: Department of Infectious Diseases, Hepatology and Acquired Immune Deficiencies, Wroclaw Medical University, Koszarowa 5, Wrocław, Poland.
authors.forename: Jacek
authors.initials: J
authors.lastname: Gąsiorowski
authors.affiliation: Department of Infectious Diseases, Jagiellonian University Medical College, Śniadeckich 5, Kraków, Poland.
authors.forename: Monika
authors.initials: M
authors.lastname: Bociąga-Jasik
authors.affiliation: Department of Infectious Diseases, Jagiellonian University Medical College, Śniadeckich 5, Kraków, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Skwara
authors.affiliation: Department of Infectious Diseases, Jagiellonian University Medical College, Śniadeckich 5, Kraków, Poland.
authors.forename: Aleksander
authors.initials: A
authors.lastname: Garlicki
authors.affiliation: Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Żurawia 14, Białystok, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Grzeszczuk
authors.affiliation: Department of Infectious Diseases and Hepatology, Medical University of Bialystok, Żurawia 14, Białystok, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Rogalska
authors.affiliation: Department of Infectious Diseases, Medical University in Gdańsk, Smoluchowskiego 18, Gdańsk, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Jankowska
authors.affiliation: Department of Infectious Diseases, Medical University in Gdańsk, Smoluchowskiego 18, Gdańsk, Poland.
authors.forename: Małgorzata
authors.initials: M
authors.lastname: Lemańska
authors.affiliation: Department of Infectious Diseases, Medical University in Gdańsk, Smoluchowskiego 18, Gdańsk, Poland.
authors.forename: Maria
authors.initials: M
authors.lastname: Hlebowicz
authors.affiliation: Department of Infectious Diseases, J. Struś Hospital, Szwajcarska 3, Poznań, Poland.
authors.forename: Grażyna
authors.initials: G
authors.lastname: Barałkiewicz
authors.affiliation: Department of Infectious Diseases, Poznan University of Medical Sciences, Szwajcarska 3, Poznań, Poland.
authors.forename: Iwona
authors.initials: I
authors.lastname: Mozer-Lisewska
authors.affiliation: Regional Hospital in Zielona Góra, Zyty 26, Zielona Góra, Poland.
authors.forename: Renata
authors.initials: R
authors.lastname: Mazurek
authors.affiliation: Regional Hospital in Zielona Góra, Zyty 26, Zielona Góra, Poland.
authors.forename: Władyslaw
authors.initials: W
authors.lastname: Lojewski
authors.affiliation: Department of Infectious Diseases and Hepatology Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Świętego Floriana 12, Bydgoszcz, Poland.
authors.forename: Edyta
authors.initials: E
authors.lastname: Grąbczewska
authors.affiliation: Department of Infectious Diseases and Hepatology Nicolaus Copernicus University Collegium Medicum in Bydgoszcz, Świętego Floriana 12, Bydgoszcz, Poland.
authors.forename: Anita
authors.initials: A
authors.lastname: Olczak
authors.affiliation: Department of Infectious Diseases and Hepatology, Medical University of Łódź, Kniaziewicza 1, Łódź, Poland.
authors.forename: Elżbieta
authors.initials: E
authors.lastname: Jabłonowska
authors.affiliation: Department of Clinical & Molecular Biochemistry, Pomeranian Medical University, Powstańców Wielkopolskich 12, Szczecin, Poland.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Clark
authors.affiliation: Department of Infectious, Tropical Diseases and Immune Deficiency, Pomeranian Medical University in Szczecin, Arkońska 4, Szczecin, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Urbańska
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D006678:HIV / Q000145:classification / Q000187:drug effects* / Q000235:genetics; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D059645:Mutation Rate; D011044:Poland / Q000453:epidemiology; D015995:Prevalence; D017422:Sequence Analysis, DNA; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D019380:Anti-HIV Agents; D054302:pol Gene Products, Human Immunodeficiency Virus
keywords: clustering; genotyping; phylogeny; subtypes; transmission networks; transmitted drug resistance