Publication: Emergence of HIV-1 drug resistance mutations among antiretroviral-naïve HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand
Issued Date
2012
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eng
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Mahidol University
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BioMed Central
Bibliographic Citation
Journal of the International AIDS Society. Vol. 15, (2012), 12
Suggested Citation
Somnuek Sungkanuparph, Chonlaphat Sukasem, Sasisopin Kiertiburanakul, Ekawat Pasomsub, Wasun Chantratita Emergence of HIV-1 drug resistance mutations among antiretroviral-naïve HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand. Journal of the International AIDS Society. Vol. 15, (2012), 12. doi:10.1186/1758-2652-15-12 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/2690
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Title
Emergence of HIV-1 drug resistance mutations among antiretroviral-naïve HIV-1-infected patients after rapid scaling up of antiretroviral therapy in Thailand
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-naïve 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/mm3 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.