title: Transmitted Drug Resistance Among Recently Diagnosed Adults and Children in São Paulo, Brazil.
abstract: Transmitted drug resistance mutations (TDRM) have been a constant threat to treatment efficacy. We evaluated TDRM in plasma RNA of 217 antiretroviral therapy-naive patients from sites in the São Paulo metropolitan area, collected from 2012 to 2014. The partial HIV-1 polymerase region was sequenced using Big Dye terminators at an ABI 3130 Genetic Analyzer. TDRM was defined according to the Stanford database calibrated population resistance (CPR v.6.0), but other drug resistance mutations (DRM) considered at the IAS list (IAS, 2014) and at the Stanford HIV Database Genotyping Resistance Interpretation (GRI-HIVdb) were also described. Out of 78% (170/217) of patients with information on the time of diagnosis, most (83%, 141/170) had been recently diagnosed, with the first positive HIV serology at a median of 58 days (IQR 18-184). Subtype B predominated (70%), followed by subtype F (10%), BF (7.5%), C (7.5%), and BC (5%). TDRMs were observed in 9.2% (20/217, CI 95% 5.9% to 13.6%), mostly (5.2%) to nonnucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral class. Among children and adolescents, only a single patient showed TDRMs. Additional non-CPR mutations were observed: 11.5% (25/217) according to IAS or 4.6% (10/217) according to GRI-HIVdb. Overall, 23.5% (51/217) of the cases had one or more DRM identified. TDRM prevalence differed significantly among some sites. These trends deserve continuous and systematic surveillance, especially with the new policies of treatment as prevention being implemented in the country.
authors.affiliation: 1 Retrovirus Laboratory, Virology Center, Adolfo Lutz Institute , São Paulo, Brazil .
authors.forename: Paula Morena de Souza
authors.initials: PM
authors.lastname: Guimarães
authors.affiliation: 1 Retrovirus Laboratory, Virology Center, Adolfo Lutz Institute , São Paulo, Brazil .
authors.forename: João Leandro de Paula
authors.initials: JL
authors.lastname: Ferreira
authors.affiliation: 1 Retrovirus Laboratory, Virology Center, Adolfo Lutz Institute , São Paulo, Brazil .
authors.forename: Luana Portes Ozório
authors.initials: LP
authors.lastname: Coelho
authors.affiliation: 1 Retrovirus Laboratory, Virology Center, Adolfo Lutz Institute , São Paulo, Brazil .
authors.forename: Jaqueline de Souza
authors.initials: Jde S
authors.lastname: Cavalcanti
authors.affiliation: 1 Retrovirus Laboratory, Virology Center, Adolfo Lutz Institute , São Paulo, Brazil .
authors.forename: Giselle Ibette Silva Lopez
authors.initials: GI
authors.lastname: Lopes
authors.affiliation: 2 Santo André Aids Program , São Paulo, Brazil .
authors.forename: Elaine Monteiro
authors.initials: EM
authors.lastname: Matsuda
authors.affiliation: 3 Division of Pediatric Infectious Diseases, Santa Casa de São Paulo Hospital , São Paulo, Brazil .
authors.forename: Flávia Jacqueline
authors.initials: FJ
authors.lastname: Almeida
authors.affiliation: 4 DST/Aids Reference Center , Campinas, Brazil .
authors.forename: Valéria Correia
authors.initials: VC
authors.lastname: Almeida
authors.affiliation: 5 Emílio Ribas Infectious Diseases Institute , São Paulo, Brazil .
authors.forename: Alexandre Ely
authors.initials: AE
authors.lastname: Campeas
authors.affiliation: 5 Emílio Ribas Infectious Diseases Institute , São Paulo, Brazil .
authors.forename: Luiz Carlos Pereira
authors.initials: LC
authors.lastname: Junior
authors.affiliation: 1 Retrovirus Laboratory, Virology Center, Adolfo Lutz Institute , São Paulo, Brazil .
authors.forename: Luís Fernando de Macedo
authors.initials: LF
authors.lastname: Brígido
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001938:Brazil; D002648:Child; D002675:Child, Preschool; D018562:Disease Transmission, Infectious; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000201:enzymology / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D008875:Middle Aged; D017422:Sequence Analysis, DNA; D055815:Young Adult; D054302:pol Gene Products, Human Immunodeficiency Virus / Q000235:genetics
chemical_list: D054302:pol Gene Products, Human Immunodeficiency Virus