HIV-1 Antiretroviral Drug Resistance Mutations in Treatment Naïve and Experienced Panamanian Subjects: Impact on National Use of EFV-Based Schemes.
The use of antiretroviral therapy in HIV infected subjects prevents AIDS-related illness and delayed occurrence of death. In Panama, rollout of ART started in 1999 and national coverage has reached 62.8% since then. The objective of this study was to determine the level and patterns of acquired drug resistance mutations of clinical relevance (ADR-CRM) and surveillance drug resistance mutations (SDRMs) from 717 HIV-1 pol gene sequences obtained from 467 ARV drug-experienced and 250 ARV drug-naïve HIV-1 subtypes B infected subjects during 2007-2013, respectively. The overall prevalence of SDRM and of ADR-CRM during the study period was 9.2% and 87.6%, respectively. The majority of subjects with ADR-CRM had a pattern of mutations that confer resistance to at least two classes of ARV inhibitors. The non-nucleoside reverse transcriptase inhibitor (NNRTI) mutations K103N and P225H were more prevalent in both ARV drug-naïve and ARV drug-experienced subjects. The nucleoside reverse transcriptase inhibitor (NRTI) mutation M184V was more frequent in ARV drug-experienced individuals, while T215YFrev and M41L were more frequent in ARV drug-naïve subjects. Prevalence of mutations associated to protease inhibitors (PI) was lower than 4.1% in both types of subjects. Therefore, there is a high level of resistance (>73%) to Efavirenz/Nevirapine, Lamivudine and Azidothymidine in ARV drug-experienced subjects, and an intermediate to high level of resistance (5-10%) to Efavirenz/Nevirapine in ARV drug-naïve subjects. During the study period, we observed an increasing trend in the prevalence of ADR-CRM in subjects under first-line schemes, but not significant changes in the prevalence of SDRM. These results reinforce the paramount importance of a national surveillance system of ADR-CRM and SDRM for national management policies of subjects living with HIV.
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.|Department of Biotechnology, Acharya Nagarjuna University, Guntur City, India.|Department of Genetics and Molecular Biology, School of Biology, University of Panama, Panama City, Panama.|Institute for Scientific Research and High Technology Services of Panama, Panama City, Panama.
Yaxelis
Y
Mendoza
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.
Juan
J
Castillo Mewa
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.|Department of Biotechnology, Acharya Nagarjuna University, Guntur City, India.|Institute for Scientific Research and High Technology Services of Panama, Panama City, Panama.
Alexander A
AA
Martínez
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.
Yamitzel
Y
Zaldívar
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.
Néstor
N
Sosa
Department of Microbiology, School of Medicine, University of Panama, Panama City, Panama.
Griselda
G
Arteaga
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.|Facultad de Ciencias de la Salud, Universidad Interamericana de Panamá, Panama City, Panama.
Blas
B
Armién
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.
Christian T
CT
Bautista
Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases (Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias), Mexico City, Mexico.
Claudia
C
García-Morales
Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases (Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias), Mexico City, Mexico.
Daniela
D
Tapia-Trejo
Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases (Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias), Mexico City, Mexico.
Santiago
S
Ávila-Ríos
Centre for Research in Infectious Diseases, National Institute of Respiratory Diseases (Centro de Investigación en Enfermedades Infecciosas, Instituto Nacional de Enfermedades Respiratorias), Mexico City, Mexico.
Gustavo
G
Reyes-Terán
Laboratório de AIDS e Imunologia Molecular, Instituto Oswaldo Cruz, FIOCRUZ, Rio de Janeiro, Brazil.
Gonzalo
G
Bello
Direction of Research and Technological Development, Gorgas Memorial Institute for Health Studies, Panama City, Panama.|Department of Microbiology, School of Medicine, University of Panama, Panama City, Panama.
Juan M
JM
Pascale
D000328:Adult; D000368:Aged; D000480:Alkynes; D019380:Anti-HIV Agents / Q000494:pharmacology*; D048588:Benzoxazines / Q000494:pharmacology; D003521:Cyclopropanes; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D019829:Nevirapine / Q000494:pharmacology; D010176:Panama; D015995:Prevalence; D012189:Retrospective Studies; D055815:Young Adult
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D019829:Nevirapine; D054303:HIV Reverse Transcriptase; C098320:efavirenz