Publication: Emergence of HIV-1 drug resistance mutations among antiretroviral-nave HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand
Issued Date
2012-03-13
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ISSN
17582652
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2-s2.0-84857942730
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Mahidol University
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SCOPUS
Bibliographic Citation
Journal of the International AIDS Society. Vol.15, No.1 (2012)
Suggested Citation
Somnuek Sungkanuparph, Chonlaphat Sukasem, Sasisopin Kiertiburanakul, Ekawat Pasomsub, Wasun Chantratita Emergence of HIV-1 drug resistance mutations among antiretroviral-nave HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand. Journal of the International AIDS Society. Vol.15, No.1 (2012). doi:10.1186/1758-2652-15-12 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/14897
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Title
Emergence of HIV-1 drug resistance mutations among antiretroviral-nave HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand
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Abstract
Background: After rapid scaling up of antiretroviral therapy in HIV-1-infected patients, the data of primary HIV-1 drug resistance in Thailand is still limited. This study aims to determine the prevalence and associated factors of primary HIV-1 drug resistance in Thailand. Methods. A prospective observational study was conducted among antiretroviral-nave HIV-1-infected Thai patients from 2007 to 2010. HIV-1 subtypes and mutations were assayed by sequencing a region of HIV-1 pol gene. Surveillance drug resistance mutations recommended by the World Health Organization for surveillance of transmitted HIV-1 drug resistance in 2009 were used in all analyses. Primary HIV-1 drug resistance was defined as the presence of one or more surveillance drug resistance mutations. Results: Of 466 patients with a mean age of 38.8 years, 58.6% were males. Risks of HIV-1 infection included heterosexual (77.7%), homosexual (16.7%), and intravenous drug use (5.6%). Median (IQR) CD4 cell count and HIV-1 RNA were 176 (42-317) cells/mm 3 and 68,600 (19,515-220,330) copies/mL, respectively. HIV-1 subtypes were CRF01-AE (86.9%), B (8.6) and other recombinants (4.5%). The prevalence of primary HIV-1 drug resistance was 4.9%; most of these (73.9%) had surveillance drug resistance mutations to only one class of antiretroviral drugs. The prevalence of patients with NRTI, NNRTI, and PI surveillance drug resistance mutations was 1.9%, 2.8% and 1.7%, respectively. From logistic regression analysis, there was no factor significantly associated with primary HIV-1 drug resistance. There was a trend toward higher prevalence in females [odds ratio 2.18; 95% confidence interval 0.896-5.304; p = 0.086]. Conclusions: There is a significant emergence of primary HIV-1 drug resistance in Thailand after rapid scaling up of antiretroviral therapy. Although HIV-1 genotyping prior to antiretroviral therapy initiation is not routinely recommended in Thailand, our results raise concerns about the risk of early treatment failure in patients with primary HIV-1 drug resistance. Interventions to prevent the transmission of HIV-1 drug resistance and continuation of surveillance for primary HIV-1 drug resistance in Thailand are indicated. © 2012 Sungkanuparph et al; licensee BioMed Central Ltd.