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Prevalence of HIV-1 transmitted drug resistance and viral suppression among recently diagnosed adults in São Paulo, Brazil

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Abstract

HIV-1 transmitted drug resistance (TDR) mutations may reduce the efficacy of antiretroviral therapy (ART), but pre-treatment testing to determine the virus genotype can improve the efficacy of ART. Unfortunately, issues related to cost and logistics of pre-treatment testing limit its use in resource-limited settings. We studied 596 ART-naive individuals who were newly diagnosed from 2014 to 2016 in São Paulo, Brazil, to evaluate TDR and virological outcome after 48 weeks of genotype-guided therapy. One or more TDR (based on the WHO surveillance list) was observed in 10.9% (CI 95%, 8.6–13.6) of the sequences, the most common of which was the K103 N mutation, which confers resistance to first-generation drugs of the non-nucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral drug class. Dual-class (1%, 6/596) and triple-class (0.34%, 2/596) resistance were uncommon. After 48 weeks of treatment with ART, infection was suppressed to below 200 copies/mL in most patients (95%), with full suppression (RNA target not detected) in 65%. The following characteristics at patient enrollment were independently associated with a lack of full suppression: CD4 T cell counts below 500 cells/µL, viremia above 100,000 copies/mL, older age, and TDR to NNRTI. The rates of resistance were intermediate, but genotype-guided therapy resulted in high rates of viral suppression. The observed resistance profile should not be an obstacle to the use of the dolutegravir-based regimen now recommended in Brazil, but genotype testing may be warranted before initiating first-generation NNRTI-based regimens.

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Acknowledgements

We acknowledge the patients and their families, health care workers and laboratory personal from the participating sites, and data management personal.

MIHR: Monitoring Incident & Recent HIV infection working group: Daniela Rodrigues Colpas, Gabriela Bastos Cabral, Giselle Ibete Silva López Lopes, Norberto Camilo Campos, Isadora Coutinho Ribeiro, Cintia Mayumi Ahagon, Guilherme Penteado Teixeira, João Leandro de Paula Ferreira, Ivana Barros de Campos, Mariana Carvalho, Rafaella Gomes, Flavia Gennari Pinheiro, Luiz Carlos Pereira Jr, Karen Morejon, Álvaro Furtado da Costa, Érika Maria do Nascimento Kalmar, Fábio Luis Nascimento Nogui, Fábio Luis Nascimento Nogui, Patrícia Rady Müller, Silvia Pereira Goulart, Suzana Toledo da Silva Leme.

Funding

FAPESP (award number 2013/19441-7 and PPSUS 2016/14813-1).

Author information

Authors and Affiliations

  1. Núcleo de Doenças Sanguíneas e Sexuais-Laboratório de Retrovírus, Centro de Virologia, Instituto Adolfo Lutz, Av Dr. Arnaldo, 355, São Paulo, SP, 01246-902, Brazil

    Luana Portes Ozorio Coelho, Giselle de Faria Romero Soldi & Luís Fernando de Macedo Brígido

  2. Programa de IST/AIDS de Santo André/SP, Santo André, Brazil

    Elaine Monteiro Matsuda

  3. Centro de Referência e Treinamento, CRT/DST-AIDS, São Paulo, SP, Brazil

    Roberta Schiavon Nogueira, Leda Fatima Jamal, José Valdez Ramalho Madruga, Mariza Vono Tancredi & Aline Carralas Queiroz de Leão

  4. Faculdade de Ciências Medicas da UNICAMP, Campinas, SP, Brazil

    Mônica Jacques de Moraes

Authors
  1. Luana Portes Ozorio Coelho
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  2. Elaine Monteiro Matsuda
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  3. Roberta Schiavon Nogueira
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  4. Mônica Jacques de Moraes
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  5. Leda Fatima Jamal
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  6. José Valdez Ramalho Madruga
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  7. Mariza Vono Tancredi
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  8. Aline Carralas Queiroz de Leão
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  9. Giselle de Faria Romero Soldi
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  10. Luís Fernando de Macedo Brígido
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Consortia

For the MIHR workgroup

  • Daniela Rodrigues Colpas
  • , Gabriela Bastos Cabral
  • , Giselle Ibete Silva López Lopes
  • , Norberto Camilo Campos
  • , Isadora Coutinho Ribeiro
  • , Cintia Mayumi Ahagon
  • , Guilherme Penteado Teixeira
  • , João Leandro de Paula Ferreira
  • , Ivana Barros de Campos
  • , Mariana Carvalho
  • , Rafaella Gomes
  • , Flavia Gennari Pinheiro
  • , Luiz Carlos Pereira Jr
  • , Karen Morejon
  • , Álvaro Furtado da Costa
  • , Érika Maria do Nascimento Kalmar
  • , Fábio Luis Nascimento Nogui
  • , Fábio Luis Nascimento Nogui
  • , Patrícia Rady Müller
  • , Silvia Pereira Goulart
  •  & Suzana Toledo da Silva Leme

Corresponding author

Correspondence to Luís Fernando de Macedo Brígido.

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Conflict of interest

No potential conflicts of interest were identified by the authors.

Ethical approval

The research involved no intervention on humans or animals, and patients in this observational study agreed to be included and signed an informed consent statement. Additional MIRH-participating institutions include Regional de Santo André do Instituto Adolfo Lutz /SP, Ambulatório de Moléstia Infecciosa, Jundiaí; Hospital das Clínicas da Faculdade de Medicina, Ribeirão Preto/SP; Instituto de Infectologia Emilio Ribas/SP.

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Handling Editor: Li Wu.

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Coelho, L.P.O., Matsuda, E.M., Nogueira, R.S. et al. Prevalence of HIV-1 transmitted drug resistance and viral suppression among recently diagnosed adults in São Paulo, Brazil. Arch Virol 164, 699–706 (2019). https://doi.org/10.1007/s00705-018-04122-8

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