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HIV-1 ANTIRETROVIRAL DRUG RESISTANCE MUTATIONS IN TREATMENT NAÏVE AND EXPERIENCED PANAMANIAN SUBJECTS: IMPACT ON NATIONAL USE OF EFV-BASED SCHEMES
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Abstract
The use of antiretroviral therapy in HIV infected subjects prevents AIDS-related illness and
delayed occurrence of death. In Panama, rollout of ART started in 1999 and national coverage
has reached 62.8% since then. The objective of this study was to determine the level
and patterns of acquired drug resistance mutations of clinical relevance (ADR-CRM) and
surveillance drug resistance mutations (SDRMs) from 717 HIV-1 pol gene sequences
obtained from 467 ARV drug-experienced and 250 ARV drug-naïve HIV-1 subtypes B
infected subjects during 2007–2013, respectively. The overall prevalence of SDRM and of
ADR-CRM during the study period was 9.2% and 87.6%, respectively. The majority of subjects
with ADR-CRM had a pattern of mutations that confer resistance to at least two classes
of ARV inhibitors. The non-nucleoside reverse transcriptase inhibitor (NNRTI)
mutations K103N and P225H were more prevalent in both ARV drug-naïve and ARV drugexperienced
subjects. The nucleoside reverse transcriptase inhibitor (NRTI) mutation
M184V was more frequent in ARV drug-experienced individuals, while T215YFrev and
M41L were more frequent in ARV drug-naïve subjects. Prevalence of mutations associated
to protease inhibitors (PI) was lower than 4.1% in both types of subjects. Therefore, there is
a high level of resistance (>73%) to Efavirenz/Nevirapine, Lamivudine and Azidothymidine
in ARV drug-experienced subjects, and an intermediate to high level of resistance (5–10%)
to Efavirenz/Nevirapine in ARV drug-naïve subjects. During the study period, we observed
an increasing trend in the prevalence of ADR-CRM in subjects under first-line schemes, but not significant changes in the prevalence of SDRM. These results reinforce the paramount
importance of a national surveillance system of ADR-CRM and SDRM for national management
policies of subjects living with HIV.
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