title: HIV-1 drug resistance surveillance in antiretroviral treatment-naive individuals from a reference hospital in Guatemala, 2010-2013.
abstract: The recent expansion of antiretroviral treatment (ART) coverage in middle/low-income countries has been associated with increasing prevalence of HIV pre-ART drug resistance (PDR). We assessed PDR prevalence, patterns, and trends in Guatemala. Blood samples from 1,084 ART-naive individuals, enrolled from October 2010 to December 2013 at the Roosevelt Hospital in Guatemala City, were obtained. PDR was evaluated using the WHO mutation list for transmitted drug resistance (TDR) surveillance. An overall PDR prevalence of 7.3% (95% CI 5.8-9.0%) was observed for the whole study period. TDR to nonnucleoside reverse transcriptase inhibitors (NNRTI) was the highest (4.9%, p<0.001), followed by nucleoside RT inhibitors (1.8%) and protease inhibitors (1.0%). No significant trends in PDR prevalence were observed during the study period. However, higher NNRTI PDR levels were found in individuals with >500 and 350-500 CD4(+) T cells/μl (7.4% and 8.7%, respectively) compared to individuals with <350 CD4(+) T cells/μl (3.7%; p=0.039 and p=0.007, respectively), as well as a tendency of higher levels of NNRTI transmitted drug resistance (DR) in individuals with recent infection determined by HIV incidence tests (9.7%), suggesting increasing trends in time. Clusters of viruses with NNRTI PDR suggesting complex transmission networks were observed. No associations between PDR and demographic variables were found. PDR in Guatemala remains at an intermediate level. Nevertheless, we have shown evidence suggesting increasing trends in NNRTI PDR, which need to be taken into account in national HIV management policies.
authors.affiliation: 1 Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases , Mexico City, Mexico.
authors.forename: Santiago
authors.initials: S
authors.lastname: Avila-Ríos
authors.forename: Claudia
authors.initials: C
authors.lastname: García-Morales
authors.forename: Daniela
authors.initials: D
authors.lastname: Garrido-Rodríguez
authors.forename: Daniela
authors.initials: D
authors.lastname: Tapia-Trejo
authors.forename: Amalia Carolina
authors.initials: AC
authors.lastname: Girón-Callejas
authors.forename: Ricardo
authors.initials: R
authors.lastname: Mendizábal-Burastero
authors.forename: Ingrid Yessenia
authors.initials: IY
authors.lastname: Escobar-Urias
authors.forename: Blanca Leticia
authors.initials: BL
authors.lastname: García-González
authors.forename: Sabrina
authors.initials: S
authors.lastname: Navas-Castillo
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Pinzón-Meza
authors.forename: Carlos Rodolfo
authors.initials: CR
authors.lastname: Mejía-Villatoro
authors.forename: Gustavo
authors.initials: G
authors.lastname: Reyes-Terán
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology*; D016000:Cluster Analysis; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D062665:Epidemiological Monitoring; D005260:Female; D005838:Genotype; D006166:Guatemala / Q000453:epidemiology; D015658:HIV Infections / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006761:Hospitals; D006801:Humans; D008297:Male; D015995:Prevalence; D011446:Prospective Studies
chemical_list: D019380:Anti-HIV Agents