title: Geolocalization of HIV-1 subtypes and resistance mutations of patients failing antiretroviral therapy in Salvador - Brazil.
abstract: BACKGROUND
  Geographical distribution of HIV variants is an important way to understand the circulation and spread of such viral strains.
  
  
  OBJECTIVE
  To evaluate the spatial distribution of HIV-1 variants in patients failing antiretroviral therapy, in Salvador, Brazil.
  
  
  METHODS
  We performed a cross-sectional evaluation of HIV resistance test reports of patients who underwent genotyping tests in a referral center in Salvador, Brazil, for the years 2008-2014. The laboratory database contains around 2500 resistance reports of patients failing antiretroviral therapy. Genotypic tests were performed by sequencing of HIV-1 POL region (TrueGene, Siemens). We assessed HIV-1 resistance mutations and subtype, as well as residential address, age, and gender of patients.
  
  
  RESULTS
  We evaluated 1300 reports, 772 (59.4%) of them from male patients. As expected, subtype B predominated (79%) followed by subtypes F1 (6.7%) and BF (6.5%). The most frequent mutations in HIV-1 reverse transcriptase were 184V (79.1%), 41L (33.5%), 67N (30.4%), 103N (42.4%), and 108I (11.1%). Most frequent mutations in HIV-1 protease were 63P (52.4%), 36I (47.9%), 15 V (33.0%), 62 V (28.1%) and 13 V (25.8%). Some mutations (41L, 215Y, 210W) were significantly more frequent among men. We detected a significantly higher accumulation of 103N mutation in specific areas of Salvador. We identified a more restricted circulation pattern for subtype FB (more frequent in some regions), and F1 (almost absent in a specific region).
  
  
  CONCLUSIONS
  Our results suggest that specific subtypes/resistance mutations present a distinct frequency rate in specific areas of Salvador, probably due to a restricted circulation pattern. This trend to clustering was observed in regions covered by AIDS referral centers, suggesting that pattern of care for such patients can interfere in virological outcomes.
authors.affiliation: LAPI - Laboratório de Pesquisa em Infectologia, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil.
authors.forename: Antonio Walter de Oliveira
authors.initials: AWO
authors.lastname: Filho
authors.affiliation: LAPI - Laboratório de Pesquisa em Infectologia, Faculdade de Medicina, Universidade Federal da Bahia, Salvador, BA, Brazil. Electronic address: crbrites@gmail.com.
authors.forename: Carlos
authors.initials: C
authors.lastname: Brites
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D003430:Cross-Sectional Studies; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D054303:HIV Reverse Transcriptase / Q000235:genetics*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D008297:Male; D009154:Mutation; D012367:RNA, Viral / Q000235:genetics; D062206:Spatial Analysis; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents; D012367:RNA, Viral; D054303:HIV Reverse Transcriptase
keywords: Brazil; Geolocalization; HIV-1; Resistance mutations