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. 2018 Mar;21(3):e25032.
doi: 10.1002/jia2.25032.

Brazilian network for HIV Drug Resistance Surveillance (HIV-BresNet): a survey of treatment-naive individuals

Monica B Arruda  1 , Lídia T Boullosa  1 , Cynthia C Cardoso  1 , Carolina M da Costa  2 , Carlos Rb Alves  3 , Shirlene Ts de Lima  4 , Helena T Kaminski  5 , Agdemir W Aleixo  6 , Ana Op Esposito  7 , Ana Ms Cavalcanti  8 , Maristela Riedel  9 , José C Couto-Fernandez  10 , Selma B Ferreira  11 , Ivi Cm de Oliveira  12 , Loreci E Portal  13 , Hilda Hc Wolf  14 , Sandra B Fernandes  15 , Maria I de M C Pardini  16 , Manoel Vc Feiteiro  17 , Fernanda M Tolentino  18 , Ricardo S Diaz  19 , Giselle Isl Lopes  20 , Roberta Bl Francisco  21 , Nazle Mc Véras  21 , Ana F Pires  21   22 , Miriam Franchini  21 , Fábio Mesquita  23 , Amilcar Tanuri  1 ; HIV-BResNet
Collaborators, Affiliations

Brazilian network for HIV Drug Resistance Surveillance (HIV-BresNet): a survey of treatment-naive individuals

Monica B Arruda et al. J Int AIDS Soc. 2018 Mar.

Abstract

Introduction: In Brazil, more than 487,450 individuals are currently undergoing antiretroviral treatment. In order to monitor the transmission of drug-resistant strains and HIV subtype distribution in the country, this work aimed to estimate its prevalence and to characterize the nationwide pretreatment drug resistance in individuals recently diagnosed with HIV between 2013 and 2015.

Methods: The HIV threshold survey methodology (HIV-THS, WHO) targeting antiretroviral-naive individuals with recent HIV diagnosis was utilized, and subjects were selected from 51 highly populated cities in all five Brazilian macroregions. The HIV pol genotypic test was performed by genomic sequencing.

Results: We analysed samples from 1568 antiretroviral-naive individuals recently diagnosed with HIV, and the overall transmitted drug resistance (TDR) prevalence was 9.5% (150 sequences). The regional prevalence of resistance according to Brazilian geographical regions was 9.4% in the northeast, 11.2% in the southeast, 6.8% in the central region, 10.2% in the north and 8.8% in the south. The inhibitor-specific TDR prevalence was 3.6% for nucleoside reverse transcriptase inhibitors (NRTIs), 5.8% for non-nucleoside reverse transcriptase inhibitors (NNRTIs) and 1.6% for protease inhibitors (PIs); 1.0% of individuals presented resistance to more than one class of inhibitors. Overall, subtype B was more prevalent in every region except for the southern, where subtype C prevails.

Conclusions: To the best of our knowledge, this is the first TDR study conducted in Brazil with nationwide representative sampling. The TDR prevalence revealed a moderate rate in the five Brazilian geographical regions, although some cities presented higher TDR prevalence rates, reaching 14% in São Paulo, for example. These results further illustrate the importance of surveillance studies for designing future strategies in primary antiretroviral therapy, aiming to mitigate TDR, as well as for predicting future trends in other regions of the globe where mass antiretroviral (ARV) treatment was implemented.

Keywords: HIV; HIV Drug Resistance Surveillance; HIV drug resistance; antiretroviral resistance; pretreatment HIV drug resistance; primary antiretroviral resistance.

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Figures

Figure 1
Figure 1
Prevalence of sequences with any SDRM (surveillance drug‐resistance mutation), any nucleoside reverse transcriptase inhibitors (NRTI) SDRM, any non‐nucleoside reverse transcriptase inhibitors (NNRTI) SDRM and protease inhibitors (PI) SDRM distributed throughout all five geographical regions in Brazil: north, northeast, central‐west, southeast, and south.
Figure 2
Figure 2
Prevalence of drug resistance mutations by drug class in antiretroviral drug‐naive patients in each of the five geographical regions. (a) nucleoside reverse transcriptase inhibitors (NRTI) (b) non‐nucleoside reverse transcriptase inhibitors (NNRTI) and (c) protease inhibitors (PI).
Figure 3
Figure 3
Distribution of subtypes throughout Brazil's five geographical regions. The map shows the distribution of subtype based on PR and RT genomic regions as well CRFs and URFs.
See this image and copyright information in PMC

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