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Prevalence of HIV-1 transmitted drug resistance and viral suppression among recently diagnosed adults in SAo Paulo, Brazil

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Autor(es):
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Ozorio Coelho, Luana Portes [1] ; Matsuda, Elaine Monteiro [2] ; Nogueira, Roberta Schiavon [3] ; de Moraes, Monica Jacques [4] ; Jamal, Leda Fatima [3] ; Ramalho Madruga, Jose Valdez [3] ; Tancredi, Mariza Vono [3] ; Queiroz de Leao, Aline Carralas [3] ; Romero Soldi, Giselle de Faria [1] ; de Macedo Brigido, Luis Fernando [1] ; Colpas, Daniela Rodrigues ; Cabral, Gabriela Bastos ; Lopes, Giselle Ibete Silva Lopez ; Campos, Norberto Camilo ; Ribeiro, Isadora Coutinho ; Ahagon, Cintia Mayumi ; Teixeira, Guilherme Penteado ; Ferreira, Joao Leandro de Paula ; de Campos, Ivana Barros ; Carvalho, Mariana ; Gomes, Rafaella ; Pinheiro, Flavia Gennari ; Pereira, Jr., Luiz Carlos ; Morejon, Karen ; da Costa, Alvaro Furtado ; Kalmar, Erika Maria do Nascimento ; Nogui, Fabio Luis Nascimento ; Mueller, Patricia Rady ; Goulart, Silvia Pereira ; Leme, Suzana Toledo da Silva ; Workgrp, MIHR
Número total de Autores: 31
Afiliação do(s) autor(es):
[1] Adolfo Lutz Inst, Ctr Virol, Lab Retrovirus, Nucleo Doencas Sanguineas Sexuais, Av Dr Arnaldo 355, BR-01246902 Sao Paulo, SP - Brazil
[2] AIDS Santo Andre, Programa IST, SP, Santo Andre - Brazil
[3] AIDS, DST, CRT, Sao Paulo, SP - Brazil
[4] Univ Estadual Campinas, Fac Ciencias Med, Campinas, SP - Brazil
Número total de Afiliações: 4
Tipo de documento: Artigo Científico
Fonte: ARCHIVES OF VIROLOGY; v. 164, n. 3, p. 699-706, MAR 2019.
Citações Web of Science: 3
Resumo

HIV-1 transmitted drug resistance (TDR) mutations may reduce the efficacy of antiretroviral therapy (ART), but pre-treatment testing to determine the virus genotype can improve the efficacy of ART. Unfortunately, issues related to cost and logistics of pre-treatment testing limit its use in resource-limited settings. We studied 596 ART-naive individuals who were newly diagnosed from 2014 to 2016 in SAo Paulo, Brazil, to evaluate TDR and virological outcome after 48weeks of genotype-guided therapy. One or more TDR (based on the WHO surveillance list) was observed in 10.9% (CI 95%, 8.6-13.6) of the sequences, the most common of which was the K103N mutation, which confers resistance to first-generation drugs of the non-nucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral drug class. Dual-class (1%, 6/596) and triple-class (0.34%, 2/596) resistance were uncommon. After 48weeks of treatment with ART, infection was suppressed to below 200 copies/mL in most patients (95%), with full suppression (RNA target not detected) in 65%. The following characteristics at patient enrollment were independently associated with a lack of full suppression: CD4 T cell counts below 500 cells/mu L, viremia above 100,000 copies/mL, older age, and TDR to NNRTI. The rates of resistance were intermediate, but genotype-guided therapy resulted in high rates of viral suppression. The observed resistance profile should not be an obstacle to the use of the dolutegravir-based regimen now recommended in Brazil, but genotype testing may be warranted before initiating first-generation NNRTI-based regimens. (AU)

Processo FAPESP: 16/14813-1 - Avaliação do uso de tecnologia de biologia molecular de detecção de viremia plasmática para identificação e incorporação de pacientes na fase aguda da infecção pelo HIV-1
Beneficiário:Ivana Barros de Campos
Modalidade de apoio: Auxílio à Pesquisa - Pesquisa em Políticas Públicas para o SUS
Processo FAPESP: 13/19441-7 - Identificação e análise de casos incidentes de infecção pelo HIV-1
Beneficiário:Luís Fernando de Macedo Brígido
Modalidade de apoio: Auxílio à Pesquisa - Regular