title: Pretreatment HIV-1 drug resistance in Argentina: results from a surveillance study performed according to WHO-proposed new methodology in 2014-15.
abstract: In Argentina, current national guidelines recommend starting with NNRTI-based regimens. Recently, there have been some local reports regarding concerning levels of NNRTI-transmitted resistance, but surveillance has never been carried out at a national level.
  
  
  
  To determine the prevalence of HIV drug resistance in people starting ART in Argentina using a WHO-proposed methodology.
  
  
  
  This was a cross-sectional, nationally representative study. Twenty-five antiretroviral-dispensing sites throughout the country were randomly chosen to enrol at least 330 persons starting ART, to generate a point prevalence estimate of resistance-associated mutations (RAMs) with a 5% CI (for the total population and for those without antiretroviral exposure). All consecutive patients older than 18 years starting or restarting ART in the chosen clinics were eligible. Samples were processed with Trugene and analysed using the Stanford algorithm.
  
  
  
  Between August 2014 and March 2015, we obtained 330 samples from people starting ART. The mean ± SD age was 35 ± 11 years, 63.4% were male, 16.6% had prior antiretroviral exposure and the median (IQR) CD4 count was 275 cells/mm3(106-461). The prevalence of RAMs found was 14% (±4%) for the whole population (3% NRTI-RAMs; 11% NNRTI-RAMs and 2% PI-RAMs) and 13% (±4%) for those without prior antiretroviral exposure (3%, 10% and 2%, respectively). The most common mutation was K103N.
  
  
  
  This surveillance study showed concerning levels of HIV drug resistance in Argentina, especially to NNRTIs. Due to this finding, Argentina's Ministry of Health guidelines will change, recommending performing a resistance test for everyone before starting ART. If this is taken up properly, it also might function as a continuing surveillance tool.
authors: Fundación Centro de Estudios Infectológicos (FUNCEI), Ciudad de Buenos Aires, Argentina ebissio@gmail.com.
authors: E
authors: E
authors: Bissio
authors: Laboratorio Central de Córdoba, Ciudad de Córdoba, Argentina.
authors: M G
authors: MG
authors: Barbás
authors: Hospital Muñiz, Ciudad de Buenos Aires, Argentina.
authors: M B
authors: MB
authors: Bouzas
authors: Laboratorio Central de Córdoba, Ciudad de Córdoba, Argentina.
authors: A
authors: A
authors: Cudolá
authors: Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina.
authors: H
authors: H
authors: Salomón
authors: Dirección de Sida, Ministerio de Salud de la Nación, Ciudad de Buenos Aires, Argentina.
authors: L
authors: L
authors: Espínola
authors: Hospital Muñiz, Ciudad de Buenos Aires, Argentina.
authors: S
authors: S
authors: Fernández Giuliano
authors: Laboratorio Central de Córdoba, Ciudad de Córdoba, Argentina.
authors: S
authors: S
authors: Kademián
authors: Hospital Muñiz, Ciudad de Buenos Aires, Argentina.
authors: L
authors: L
authors: Mammana
authors: Instituto de Investigaciones Biomédicas en Retrovirus y SIDA (INBIRS), Universidad de Buenos Aires, Ciudad de Buenos Aires, Argentina.
authors: M L Suárez
authors: ML
authors: Ornani
authors: Pan American Health Organization, Washington, DC, USA.
authors: G
authors: G
authors: Ravasi
authors: Pan American Health Organization, Ciudad de Buenos Aires, Argentina.
authors: M
authors: M
authors: Vila
authors: Hospital Muñiz, Ciudad de Buenos Aires, Argentina.
authors: I
authors: I
authors: Zapiola
authors: Dirección de Sida, Ministerio de Salud de la Nación, Ciudad de Buenos Aires, Argentina.
authors: C
authors: C
authors: Falistocco
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D001118:Argentina; D018791:CD4 Lymphocyte Count; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1 / Q000187:drug effects*; D006801:Humans; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D013938:Thymidine Monophosphate / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; C498574:NNRTI MKC-442; D018894:Reverse Transcriptase Inhibitors; D013938:Thymidine Monophosphate