title: HIV Drug Resistance Surveillance in Honduras after a Decade of Widespread Antiretroviral Therapy.
abstract: BACKGROUND
  We assessed HIV drug resistance (DR) in individuals failing ART (acquired DR, ADR) and in ART-naïve individuals (pre-ART DR, PDR) in Honduras, after 10 years of widespread availability of ART.
  
  
  METHODS
  365 HIV-infected, ART-naïve, and 381 ART-experienced Honduran individuals were enrolled in 5 reference centres in Tegucigalpa, San Pedro Sula, La Ceiba, and Choluteca between April 2013 and April 2015. Plasma HIV protease-RT sequences were obtained. HIVDR was assessed using the WHO HIVDR mutation list and the Stanford algorithm. Recently infected (RI) individuals were identified using a multi-assay algorithm.
  
  
  RESULTS
  PDR to any ARV drug was 11.5% (95% CI 8.4-15.2%). NNRTI PDR prevalence (8.2%) was higher than NRTI (2.2%) and PI (1.9%, p<0.0001). No significant trends in time were observed when comparing 2013 and 2014, when using a moving average approach along the study period or when comparing individuals with >500 vs. <350 CD4+ T cells/μL. PDR in recently infected individuals was 13.6%, showing no significant difference with PDR in individuals with longstanding infection (10.7%). The most prevalent PDR mutations were M46IL (1.4%), T215 revertants (0.5%), and K103NS (5.5%). The overall ADR prevalence in individuals with <48 months on ART was 87.8% and for the ≥48 months on ART group 81.3%. ADR to three drug families increased in individuals with longer time on ART (p = 0.0343). M184V and K103N were the most frequent ADR mutations. PDR mutation frequency correlated with ADR mutation frequency for PI and NNRTI (p<0.01), but not for NRTI. Clusters of viruses were observed suggesting transmission of HIVDR both from ART-experienced to ART-naïve individuals and between ART-naïve individuals.
  
  
  CONCLUSIONS
  The global PDR prevalence in Honduras remains at the intermediate level, after 10 years of widespread availability of ART. Evidence of ADR influencing the presence of PDR was observed by phylogenetic analyses and ADR/PDR mutation frequency correlations.
authors.affiliation: 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.affiliation: Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
authors.forename: Claudia
authors.initials: C
authors.lastname: García-Morales
authors.affiliation: Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
authors.forename: Daniela
authors.initials: D
authors.lastname: Tapia-Trejo
authors.affiliation: HIV National Programme and National Laboratory, Honduran Ministry of Health, Tegucigalpa, Honduras.
authors.forename: Rita I
authors.initials: RI
authors.lastname: Meza
authors.affiliation: HIV National Programme and National Laboratory, Honduran Ministry of Health, Tegucigalpa, Honduras.
authors.forename: Sandra M
authors.initials: SM
authors.lastname: Nuñez
authors.affiliation: HIV National Programme and National Laboratory, Honduran Ministry of Health, Tegucigalpa, Honduras.
authors.forename: Leda
authors.initials: L
authors.lastname: Parham
authors.affiliation: Instituto Nacional Cardio Pulmonar, Tegucigalpa, Honduras.
authors.forename: Norma A
authors.initials: NA
authors.lastname: Flores
authors.affiliation: Hospital Mario Catarino Rivas, San Pedro Sula, Honduras.
authors.forename: Diana
authors.initials: D
authors.lastname: Valladares
authors.affiliation: Hospital Mario Catarino Rivas, San Pedro Sula, Honduras.
authors.forename: Luisa M
authors.initials: LM
authors.lastname: Pineda
authors.affiliation: Unidad de Salud Metropolitana, La Ceiba, Honduras.
authors.forename: Dixiana
authors.initials: D
authors.lastname: Flores
authors.affiliation: Unidad de Salud Metropolitana, La Ceiba, Honduras.
authors.forename: Roxana
authors.initials: R
authors.lastname: Motiño
authors.affiliation: Hospital del Sur, Choluteca, Honduras.
authors.forename: Víctor
authors.initials: V
authors.lastname: Umanzor
authors.affiliation: Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.
authors.forename: Candy
authors.initials: C
authors.lastname: Carbajal
authors.affiliation: Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.
authors.forename: Wendy
authors.initials: W
authors.lastname: Murillo
authors.affiliation: Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.
authors.forename: Ivette
authors.initials: I
authors.lastname: Lorenzana
authors.affiliation: Universidad Nacional Autónoma de Honduras, Tegucigalpa, Honduras.|Hospital Escuela Universitario, Tegucigalpa, Honduras.
authors.forename: Elsa Y
authors.initials: EY
authors.lastname: Palou
authors.affiliation: Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
authors.forename: Gustavo
authors.initials: G
authors.lastname: Reyes-Terán
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use*; D015496:CD4-Positive T-Lymphocytes / Q000166:cytology / Q000276:immunology; D003710:Demography; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology; D015497:HIV-1 / Q000145:classification / Q000235:genetics; D006721:Honduras / Q000453:epidemiology; D006801:Humans; D008297:Male; D009154:Mutation; D010802:Phylogeny; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood
chemical_list: D044966:Anti-Retroviral Agents; D012367:RNA, Viral