National survey of pre-treatment HIV drug resistance in Cuban patients

Abstract

Background: The World Health Organization (WHO) recommends a method to estimate nationally representative pretreatment HIV drug resistance (PDR) in order to evaluate the effectiveness of first -line treatments. The objective of the present study was to determine the prevalence of PDR in Cuban adults infected with HIV-1.

Materials and methods: A cross-sectional study in Cuban adults infected with HIV-1 over 18 years was conducted. The probability proportional to size method for the selection of municipalities and patients without a prior history of antiretroviral treatment during the period from January 2017 to June 2017 was used. The plasma from 141 patients from 15 municipalities for the determination of viral subtype and HIV drug resistance was collected. Some clinical and epidemiological variables were evaluated.

Results: 80. 9% of the patients corresponded to the male sex and 76.3% were men who have sex with other men (MSM). The median CD4 count was 371 cells / mm3 and the median viral load was 68000 copies / mL. The predominant genetic variants were subtype B (26.9%), CRF19_cpx (24.1%), CRF 20, 23, 24_BG (23.4%) and CRF18_cpx (12%). Overall, the prevalence of PDR was 29.8% (95%, CI 22.3-38.1). The prevalence was 12.8% (95%, CI 6.07-16.9) for any nucleoside reverse transcriptase inhibitor (NRTI), 23.4% (95%, CI 16.7-31.3) for any non-reverse transcriptase inhibitor (NNRTI) and 1.4% (95%, CI 0.17-5.03) for any protease inhibitor (PI). The most frequent mutations detected were K103N (12.9%), G190A (6.4%) and Y181C (4.8%).

Conclusions: The NNRTI prevalence above 10% in our study indicates that the first-line antiretroviral therapy in Cuba may be less effective and supports the need to look for new treatment options that contribute to therapeutic success and help the country achieve the global goals 90-90-90 set forth by UNAIDS.

Fig 1. Levels of HIV-1 resistance to antiretrovirals.

Pre-treatment resistance levels of HIV-1 by antiretroviral drug were estimated from HIV-1 protease-RT sequences using the Stanford HIVdb tool algorithm (v 8.3). The levels of antiretroviral resistance according to the Stanford score (SS) were classified as: high, ≥60; intermediate, 30–50; or low (≥15–29). The pre-treatment resistance of HIV-1 is shown for the most frequently used treatment combinations. ATV/r: atazanavir/ritonavir; DRV/r: darunavir/ritonavir; LPV/r: lopinavir/ritonavir; ABC: abacavir; AZT: zidovudine; D4T: stavudine; DDI: didanosine; FTC: emtricitabine; 3TC: lamivudine; TDF: tenofovir; NVP: nevirapine, EFV: efavirenz.