title: Transmitted Drug Resistance Mutations in Antiretroviral-Naïve Injection Drug Users with Chronic HIV-1 Infection in Iran.
abstract: The growing incidence and transmission of drug resistant HIV-1 strains due to widespread use of antiretroviral therapy (ART) can jeopardize the success of first-line ART. While there is a known moderate prevalence of transmitted drug resistance (TDR) among newly infected Iranians, no data exist about the rate of these primary resistance mutations among the ART-naïve, chronically infected individuals who are, in fact, the main candidates for ART initiation. To address this issue, we collected blood samples from 40 ART-naïve injection drug-users (IDUs) with chronic HIV-1 infection (seroconversion time ranging from 2 to 9 years) living in Sanandaj, Iran, followed by sequencing of the protease and reverse-transcriptase regions from their HIV-1 genome. Phylogenetic analyses of the sequenced regions revealed that all samples were CRF35_AD. Transmitted resistance mutations were interpreted as surveillance drug-resistant mutations (SDRMs) based on the world health organization (WHO) algorithm. The frequency of SDRMs to any class of antiretroviral drugs was 15%, which included mutations to nucleoside reverse transcriptase inhibitors (NRTIs, 10%), with M41L and M184V as the most common (5%), and non-nucleoside reverse transcriptase inhibitors (NNRTIs, 5%), with K103N as the only detected mutation (5%). Although not in the WHO SDRMs list, several minor protease inhibitor resistant mutations listed in the International Antiviral Society-USA panel were identified, of which M36I, H69K, L89M/V/I (each one 100%) and K20R/T (92.5%) can be considered as polymorphic signatures for CRF35_AD.The relatively high rate of TDR mutations in our study raises concerns about the risk of treatment failure in chronically infected IDUs of Sanandaj city. These results suggest that routine resistance testing should be considered before the therapy initiation in this area. Additional surveillance studies are required to generalize this deduction to other cities of Iran.
authors.affiliation: Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran.
authors.forename: Arash
authors.initials: A
authors.lastname: Memarnejadian
authors.affiliation: Department of Pathology and Medical Laboratory Sciences, Faculty of Paramedicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Shahoo
authors.initials: S
authors.lastname: Menbari
authors.affiliation: Department of Microbiology, Faculty of Sciences, Islamic Azad University, Qom, Iran.
authors.forename: Seyed Ali
authors.initials: SA
authors.lastname: Mansouri
authors.affiliation: Department of Microbiology, Faculty of Sciences, Islamic Azad University, Karaj, Iran.
authors.forename: Leila
authors.initials: L
authors.lastname: Sadeghi
authors.affiliation: Department of Virology, Faculty of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
authors.forename: Rouhollah
authors.initials: R
authors.lastname: Vahabpour
authors.affiliation: Department of Hepatitis and AIDS, Pasteur Institute of Iran, Tehran, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Aghasadeghi
authors.affiliation: Department of Epidemiology, Pasteur Institute of Iran, Tehran, Iran.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Mostafavi
authors.affiliation: Department of Pathology and Medical Laboratory Sciences, Faculty of Paramedicine, Kurdistan University of Medical Sciences, Sanandaj, Iran.
authors.forename: Mohammad
authors.initials: M
authors.lastname: Abdi
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D055030:Drug Users; D005260:Female; D005814:Genes, Viral; D005838:Genotype; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology*; D006679:HIV Seropositivity; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008826:Microbial Sensitivity Tests; D009154:Mutation; D010802:Phylogeny; D012307:Risk Factors
chemical_list: D019380:Anti-HIV Agents