Short Communication: Integrase Strand Transfer Inhibitors Drug Resistance Mutations in Puerto Rico HIV-Positive Individuals

Abstract

The HIV-1 integrase viral protein is responsible for incorporating the viral DNA into the genomic DNA. The inhibition of viral integration into host cell DNA is part of recent therapeutic procedures. Combination therapy with protease and reverse transcriptase inhibitors has demonstrated good synergistic results in reducing viral replication. The purpose of this study is to assess the occurrence of integrase drug resistance mutations from the period comprising 2013 through 2018 in Puerto Rico (PR). We analyzed 131 nucleotide sequences available in our HIV genotyping database, and we performed drug resistance mutation analyses using the Stanford HIV Drug Resistance Database. Twenty-one sequences (16.03%) harbored major or resistance-associated mutations. We identified the Q148HKR, G140S, Y143R, N155H, S147G, and E138EA major drug resistance mutations and the D232DN, T97TA, E157Q, G163GART accessory mutations. We detected high-level drug resistance to Elvitegravir and Raltegravir (76.19% and 85.71%). Moreover, we identified sequences harboring drug resistance mutations that could provide resistance to Dolutegravir. The transmission of strains with integrase antiretroviral resistance has been previously documented in treatment naïve patients. Given the increase of patients treated with integrase inhibitors, surveillance of drug resistance mutations is an essential aspect of PR's clinical management of HIV infection.

Keywords: HIV-1; bictegravir; dolutegravir; elvitegravir; integrase resistance mutations; raltegravir.

Figure 1

HIV-1 integrase sequences harboring major or accessory drug resistance mutations decrease over time. No INSTIs drug resistance mutations were detected among the 42 sequences analyzed from 2018. The numbers in each bar represent the total number of integrase sequences analyzed.

Figure 2

Occurrence of major and accessory INSTI-resistance mutations among HIV-1 patients in Puerto Rico. (A) Shows the observed frequency of the integrase mutations Q148HKR, G140S, N155H, S147G, E138EA, and Y143R on our studied samples. (B) Frequency of integrase accessory mutations D232DN, T97TA, E157Q, and G163GART detected in patient samples.

Figure 3

Resistance mutations among HIV-1 patients in Puerto Rico. HIV-1 integrase sequences harboring high-level, intermediate, potential low-level and low-level resistance mutations to Bictegravir (BIC), Dolutegravir (DTG), Elvitegravir (EVG), and Raltegravir (RAL) INSTIs.