title: Antiretroviral drug resistance mutations in naïve and experienced patients in Shiraz, Iran, 2014.
abstract: Resistance to antiretroviral agents is a significant concern in the clinical management of HIV-infected individuals, particularly in areas of the world where treatment options are limited. In this study, we aimed to identify HIV drug-resistance-associated mutations in 40 drug-naïve patients and 62 patients under antiretroviral therapy (ART) referred to the Shiraz HIV/AIDS Research Center - the first such data available for the south of Iran. HIV reverse transcriptase and protease genes were amplified and sequenced to determine subtypes and antiretroviral- resistance-associated mutations (RAMs). Subtype CRF35-AD recombinant was the most prevalent in all patients (98 of 102, 96 %), followed by subtype A1, and subtype B (one each, 2 %). Among the 40 ART-naïve patients, two mutations associated with nucleoside reverse transcriptase inhibitor (NRTI) resistance (two with Y115F and T215I) and three associated with non-nucleoside reverse transcriptase inhibitor (NNRTI) resistance (two with G190S and Y181C, four with V179T) were found. Among ART-experienced patients, four mutations associated with resistance to NRTI, four with NNRTI, and five with protease inhibitors (PI) were found. Twenty patients with high levels of resistance were already on second-line therapy. We document for the first time in this region of Iran high levels of ART resistance to multiple drugs. Our findings call for more vigilant systematic ART resistance surveillance, increased resistance testing, careful management of patients with existing regimens, and strong advocacy for expansion of available drugs in Iran.
authors.affiliation: Department of Virology, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.|Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Falsafi Educational Campus, Shaskalate, 5th km Gorgan, Tehran Rd., Gorgan, Iran.
authors.forename: Hamed
authors.initials: H
authors.lastname: Naziri
authors.affiliation: Department of Hepatitis and AIDS, Pasteur Institute of Iran, Pasteur Ave., Tehran, 1316943551, Iran. kbaesi@gmail.com.
authors.forename: Kazem
authors.initials: K
authors.lastname: Baesi
authors.affiliation: Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Falsafi Educational Campus, Shaskalate, 5th km Gorgan, Tehran Rd., Gorgan, Iran. abmoradi@yahoo.com.
authors.forename: Abdolvahab
authors.initials: A
authors.lastname: Moradi
authors.affiliation: Department of Hepatitis and AIDS, Pasteur Institute of Iran, Pasteur Ave., Tehran, 1316943551, Iran.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Aghasadeghi
authors.affiliation: Department of Microbiology, School of Medicine, Golestan University of Medical Sciences, Falsafi Educational Campus, Shaskalate, 5th km Gorgan, Tehran Rd., Gorgan, Iran.
authors.forename: Alijan
authors.initials: A
authors.lastname: Tabarraei
authors.affiliation: Department of Epidemiology and Biostatistics, University of California, San Francisco, San Francisco, CA, USA.
authors.forename: Willi
authors.initials: W
authors.lastname: McFarland
authors.affiliation: Shiraz HIV and AIDS Research Center, Shiraz University of Medical Sciences, Shiraz, Iran.
authors.forename: Mohamad Ali
authors.initials: MA
authors.lastname: Davarpanah
mesh_terms: D000328:Adult; D000998:Antiviral Agents / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D015967:Gene Expression Regulation, Viral; D015658:HIV Infections / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D054298:Human Immunodeficiency Virus Proteins / Q000235:genetics / Q000378:metabolism; D006801:Humans; D007492:Iran / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009154:Mutation
chemical_list: D000998:Antiviral Agents; D054298:Human Immunodeficiency Virus Proteins