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Prevalence and patterns of primary resistance to antiretroviral drugs among untreated individuals infected with HIV type-1 from Croatia

BACKGROUND: Our aim was to determine the prevalence of resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs) and protease inhibitors )PIs) and patterns of resistance mutations in treatment-naive HIV- infected patients from Croatia. Croatia has a centralized system of clinical care at the University Hospital for Infectious Diseases (UHID) in Zagreb. METHODS: The study enrolled treatment- naive adult HIV-infected patients that entered clinical care at UHID between 2006 and 2008 with plasma viraemia >1, 000 HIV-1 RNA copies/ml and sufficient volume of stored plasma for resistance testing. The protease gene and a part of reverse transcriptase gene of HIV were sequenced using the Trugene HIV-1 Genotyping System. The prevalence of transmitted drug resistance was analysed using the surveillance drug resistance mutations (SDRMs) list recommended by the World Health Organization in 2009. Clinical significance of resistance mutations was interpreted as recommended by the International AIDS Society-USA Drug Resistance Mutations Group update 2009. RESULTS: A total of 179 treatment-naive HIV-infected patients entered clinical care at the Croatian Reference Center for HIV/AIDS in the period 2006-2008. We reported that 116 out of 159 eligible patients (73% coverage) SDRM associated with primary resistance to NRTIs were detected in 10 of 116 patients (16.4%). The most frequently found NRTI SDRM was 215S (12 of 116 patients, 10.3%). NNRTI SDRM was detected in one patients (101E) and one patients had a combination of SDRM associated with resistance to NRTIs and NNRTIs (215S and 103N). IAS-USA drug resistance mutations to NRTIs (210W and 77L) were found in 5 of 116 patients (4.3%) and to NNRTIs (101E and 103N) in 2 of 116 patients (1.7%). Primary resistance to PIs was not detected in Croatian patients. The majority of analysed patients (103/116, 88.8%) were infected with genotype B, whereas non-B genotypes were detected in 13 patients only: genotype C (n=4), genotype A (n=4), CRF_01_AE(PR)/A(RT) (n=1), C(PR)/A(RT) (n=1), C(PR)/CRF_01_AE(RT) (n=1) and CRF02_AG (n=2). SDRMs were detected in patients infected with genotype B only. CONCLUSIONS: This study has shown that ART-resistant HIV is transmitted among Croatian patients. The most frequently found SDRMs were T215 revertants. Prevalence of resistance to NNRTI was low.

Antiretroviral drug ; resistance ; HIV-1 ; Croatia

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