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Planinić A, Begovac J, Rokić F, Šimičić P, Oroz M, Jakovac K, Vugrek O, Zidovec-Lepej S. Characterization of Human Immunodeficiency Virus-1 Transmission Clusters and Transmitted Drug-Resistant Mutations in Croatia from 2019 to 2022. Viruses 2023; 15:2408. [PMID: 38140649 PMCID: PMC10747707 DOI: 10.3390/v15122408] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/04/2023] [Accepted: 12/09/2023] [Indexed: 12/24/2023] Open
Abstract
Molecular epidemiology of HIV-1 infection is challenging due to the highly diverse HIV-genome. We investigated the genetic diversity and prevalence of transmitted drug resistance (TDR) followed by phylogenetic analysis in 270 HIV-1 infected, treatment-naïve individuals from Croatia in the period 2019-2022. The results of this research confirmed a high overall prevalence of TDR of 16.7%. Resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside RTIs (NNRTIs), and protease inhibitors (PIs) was found in 9.6%, 7.4%, and 1.5% of persons, respectively. No resistance to integrase strand-transfer inhibitors (INSTIs) was found. Phylogenetic analysis revealed that 173/229 sequences (75.5%) were part of transmission clusters, and the largest identified was T215S, consisting of 45 sequences. Forward transmission was confirmed in several clusters. We compared deep sequencing (DS) with Sanger sequencing (SS) on 60 randomly selected samples and identified additional surveillance drug resistance mutations (SDRMs) in 49 of them. Our data highlight the need for baseline resistance testing in treatment-naïve persons. Although no major INSTIs were found, monitoring of SDRMs to INSTIs should be continued due to the extensive use of first- and second-generation INSTIs.
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Affiliation(s)
- Ana Planinić
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases Dr. Fran Mihaljević, 10000 Zagreb, Croatia;
| | - Josip Begovac
- School of Medicine, University of Zagreb, 10000 Zagreb, Croatia;
| | - Filip Rokić
- Ruđer Bošković Institute, 10000 Zagreb, Croatia; (F.R.); (K.J.); (O.V.)
| | - Petra Šimičić
- Department of Oncology and Nuclear Medicine, Sestre Milosrdnice University Hospital Center, 10000 Zagreb, Croatia;
| | - Maja Oroz
- Cytogenetic Laboratory, Department of Obstetrics and Gynecology, Clinical Hospital Sveti Duh, 10000 Zagreb, Croatia;
| | - Katja Jakovac
- Ruđer Bošković Institute, 10000 Zagreb, Croatia; (F.R.); (K.J.); (O.V.)
| | - Oliver Vugrek
- Ruđer Bošković Institute, 10000 Zagreb, Croatia; (F.R.); (K.J.); (O.V.)
| | - Snjezana Zidovec-Lepej
- Department of Immunological and Molecular Diagnostics, University Hospital for Infectious Diseases Dr. Fran Mihaljević, 10000 Zagreb, Croatia;
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Ferrer P, Ramos V, Puente MI, Afani A. Preliminary report of transmitted drug resistance to integrase strand chain transfer inhibitors in treatment-naïve HIV infected patients. Diagn Microbiol Infect Dis 2023; 107:116083. [PMID: 37778156 DOI: 10.1016/j.diagmicrobio.2023.116083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 08/28/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023]
Abstract
Transmitted Resistance exists in a newly diagnosed person who has not yet started their treatment. Our objective was to obtain a profile of HIV-1 resistance to integrase inhibitors in newly diagnosed treatment-naïve patients. Fifty people newly diagnosed with HIV-1 infection who had never received antiretroviral treatment were recruited. The complete integrase gene was amplified by nested RTPCR and the sequences obtained were analyzed with the ReCall and HIVdb v9.0. The overall prevalence transmitted due to mutations with some impact on integrase strand transfer inhibitors (INSTI) activity during the study period was 8%. The major E138K mutation was detected in only 1 patient and the secondary G163R mutation was detected in the other 3. The transmitted resistance for the first generation INSTI was 8% and for the second generation it was 0%. In Chile the resistance transmitted to INSTI is low and it is in according values detect in other part of the world.
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Affiliation(s)
- Pablo Ferrer
- Laboratorio de Medicina Molecular, Hospital Clínico Universidad de Chile, Santiago, Chile.
| | - Verónica Ramos
- Laboratorio de Medicina Molecular, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Maria Ignacia Puente
- Laboratorio de Medicina Molecular, Hospital Clínico Universidad de Chile, Santiago, Chile
| | - Alejandro Afani
- Laboratorio de Medicina Molecular, Hospital Clínico Universidad de Chile, Santiago, Chile
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Uno S, Gatanaga H, Hayashida T, Imahashi M, Minami R, Koga M, Samukawa S, Watanabe D, Fujii T, Tateyama M, Nakamura H, Matsushita S, Yoshino Y, Endo T, Horiba M, Taniguchi T, Moro H, Igari H, Yoshida S, Teshima T, Nakajima H, Nishizawa M, Yokomaku Y, Iwatani Y, Hachiya A, Kato S, Hasegawa N, Yoshimura K, Sugiura W, Kikuchi T. Virological outcomes of various first-line ART regimens in patients harbouring HIV-1 E157Q integrase polymorphism: a multicentre retrospective study. J Antimicrob Chemother 2023; 78:2859-2868. [PMID: 37856677 DOI: 10.1093/jac/dkad319] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 09/16/2023] [Indexed: 10/21/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitors (INSTIs) are recommended as first-line ART for people living with HIV (PLWH) in most guidelines. The INSTI-resistance-associated mutation E157Q, a highly prevalent (2%-5%) polymorphism of the HIV-1 (human immunodeficiency virus type 1) integrase gene, has limited data on optimal first-line ART regimens. We assessed the virological outcomes of various first-line ART regimens in PLWH with E157Q in real-world settings. METHODS A multicentre retrospective observational study was conducted on PLWH who underwent integrase genotypic drug-resistance testing before ART initiation between 2008 and 2019 and were found to have E157Q. Viral suppression (<50 copies/mL) rate at 24 and 48 weeks, time to viral suppression and time to viral rebound (≥100 copies/mL) were compared among the first-line ART regimens. RESULTS E157Q was detected in 167 (4.1%) of 4043 ART-naïve PLWH. Among them, 144 had available clinical data after ART initiation with a median follow-up of 1888 days. Forty-five started protease inhibitors + 2 NRTIs (PI group), 33 started first-generation INSTI (raltegravir or elvitegravir/cobicistat) + 2 NRTIs (INSTI-1 group), 58 started once-daily second-generation INSTI (dolutegravir or bictegravir) + 2 NRTIs (INSTI-2 group) and eight started other regimens. In the multivariate analysis, the INSTI-2 group showed similar or favourable outcomes compared with the PI group for viral suppression rates, time to viral suppression and time to viral rebound. Two cases in the INSTI-1 group experienced virological failure. CONCLUSIONS The general guideline recommendation of second-generation INSTI-based first-line ART for most PLWH is also applicable to PLWH harbouring E157Q.
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Affiliation(s)
- Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Gatanaga
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tsunefusa Hayashida
- AIDS Clinical Center, National Center for Global Health and Medicine, Tokyo, Japan
| | - Mayumi Imahashi
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - Rumi Minami
- Department of Internal Medicine, Immunology and Infectious diseases, Clinical Research Center, National Hospital Organization Kyushu Medical Center, Fukuoka, Japan
| | - Michiko Koga
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
| | - Sei Samukawa
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Dai Watanabe
- AIDS Medical Center, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | - Teruhisa Fujii
- Division of Transfusion Medicine, Hiroshima University Hospital, Hiroshima, Japan
| | - Masao Tateyama
- Department of Infectious, Respiratory and Digestive Medicine, Graduate School of Medicine, University of the Ryukyus, Okinawa, Japan
| | - Hideta Nakamura
- First Department of Internal Medicine, Division of Infectious, Respiratory, and Digestive Medicine, University of the Ryukyus Graduate School of Medicine, Okinawa, Japan
| | - Shuzo Matsushita
- Clinical Retrovirology, Joint Research Center for Human Retrovirus Infection, Kumamoto University, Kumamoto, Japan
| | - Yusuke Yoshino
- Department of Internal Medicine, Teikyo University School of Medicine, Tokyo, Japan
| | - Tomoyuki Endo
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Masahide Horiba
- Department of Respiratory Medicine, NHO Higashisaitama National Hospital, Saitama, Japan
| | | | - Hiroshi Moro
- Department of Respiratory Medicine and Infectious Diseases, Niigata University Graduate School of Medical and Dental Sciences, Niigata, Japan
| | - Hidetoshi Igari
- Department of Infectious Diseases, Chiba University Hospital, Chiba, Japan
| | - Shigeru Yoshida
- School of Medical Technology, Health Science University of Hokkaido, Hokkaido, Japan
| | - Takanori Teshima
- Department of Hematology, Hokkaido University Hospital, Sapporo, Japan
| | - Hideaki Nakajima
- Department of Hematology and Clinical Immunology, Yokohama City University School of Medicine, Kanagawa, Japan
| | - Masako Nishizawa
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
| | - Yoshiyuki Yokomaku
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - Yasumasa Iwatani
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - Atsuko Hachiya
- Clinical Research Center, National Hospital Organization Nagoya Medical Center, Aichi, Japan
| | - Shingo Kato
- Hanah MediTech, Co. Ltd., Tokyo, Japan
- Department of Microbiology and Immunology, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | | | - Wataru Sugiura
- Center for Clinical Sciences, National Center for Global Health and Medicine, Tokyo, Japan
| | - Tadashi Kikuchi
- Division of Infectious Diseases, Advanced Clinical Research Center, Institute of Medical Science, University of Tokyo, Tokyo, Japan
- AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
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Liu J, Liu C, Wang Y, Wei S, Ma J, Li Y, Chen X, Zhao Q, Huo Y. Increased prevalence of pretreatment drug resistance mutations in treatment-naïve people living with HIV-1 in Henan Province, China (2022/23). INFECTION, GENETICS AND EVOLUTION : JOURNAL OF MOLECULAR EPIDEMIOLOGY AND EVOLUTIONARY GENETICS IN INFECTIOUS DISEASES 2023; 115:105520. [PMID: 37898414 DOI: 10.1016/j.meegid.2023.105520] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/20/2023] [Revised: 10/19/2023] [Accepted: 10/25/2023] [Indexed: 10/30/2023]
Abstract
Human deficiency virus type 1 (HIV-1) harboring drug resistance mutations (DRMs) before the initiation of antiretroviral therapy (ART) poses a serious threat to the efficacy of current ART regimens. Currently, the prevalence of pre-treatment drug resistance mutations (PDRMs) including transmitted DRMs (TDRMs) is not completely clear. Understanding this prevalence better should offer valuable data for clinical- and government-level decision-making. To closely monitor the PDRM trend in treatment-naïve people living with HIV/AIDS (PLWHA) in Henan Province, China, plasma samples from the patients seeking treatments at our hospital from January 2022 to February 2023 were collected for genotypic drug resistance testing. From the 645 patients whose samples were collected, partial pol and integrase gene sequences were obtained from 637 patients. Subtyping analysis indicated that the top-three most common subtypes, in descending order, were CRF07_BC (41.76%, 266/637), CRF01_AE (28.26%, 180/637), and B (20.41%, 130/637). PDRMs were observed in 5.18% (33/637), 6.28% (40/637), 0.31% (2/637), and 2.83% (18/637) cases for nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), protease inhibitors (PIs), and integrase strand transfer inhibitors (INSTIs), respectively; all these medications contributed to an overall PDRM prevalence of 11.93% (76/637). On analyzing individual PDRMs, we noted that the most commonly observed mutation(s) were K103S/N (3.77%, 24/637), M184I/V (3.14%, 20/637), followed by K65R (1.26%, 8/637), and V106A/M (1.10%, 7/637). PDRM prevalence in ART-naïve PLWHA of Henan Province is high and increased compared with that noted in previous years. However, evidence of cluster-linked outbreaks of PDRMs is lacking, suggesting that measures such as education about adherence and improved treatment strategies with a low incidence of failure can effectively reduce PDRM prevalence.
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Affiliation(s)
- Jinjin Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China
| | - Chunli Liu
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China
| | - Yanli Wang
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China
| | - Shuguang Wei
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China
| | - Jie Ma
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China
| | - Yuanyuan Li
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China
| | - Xuhui Chen
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China
| | - Qingxia Zhao
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China.
| | - Yuqi Huo
- The Sixth People's Hospital of Zhengzhou, Zhengzhou 450000, China.
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Basso M, Battagin G, Nicolè S, Rossi MC, Colombo F, Pirola N, Baratti S, Storato S, Giovagnorio F, Malagnino V, Alessio G, Vinci A, Maurici M, Sarmati L, Parisi SG. Predicting Factors of Plasma HIV RNA Undetectability after Switching to Co-Formulated Bictegravir, Emtricitabine, and Tenofovir Alafenamide in Experienced HIV-1 Patients: A Multicenter Study. Viruses 2023; 15:1727. [PMID: 37632071 PMCID: PMC10458950 DOI: 10.3390/v15081727] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2023] [Revised: 08/01/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023] Open
Abstract
Switching to bictegravir, emtricitabine, and tenofovir alafenamide (BIC/FTC/TAF) from other antiretroviral regimens is safe and effective for virologically suppressed people living with HIV (PLWH). The term virological suppression includes both low but detectable HIV viremia and undetectable HIV viremia, and the latter is possibly associated with a lower immune activation state. Herein, we describe a 24-month follow-up of experienced PLWH with plasma HIV RNA undetectable or detectable < 50 copies/ml switching to BIC/FTC/TAF. A previous 12-month monitoring was available, and the factors correlated with treatment efficacy. This retrospective multicenter study included PLWH who switched to BIC/FTC/TAF in the period of 2019-2022, and who were HBsAg and HCV RNA negative. The follow-up study times were 6 (T6), 12 (T12), 18 (T18), and 24 (T24) months after the switch (T0). Survival analysis with multiple-failure-per-subject design, Kaplan-Meier survival estimates, multivariate analysis of variance, multilevel linear regression, and a hierarchical ordered logistic model were applied. A total of 329 PLWH had plasma HIV RNA which was either undetectable or detectable at <50 copies/mL at T0, and 197 responded to all inclusion criteria: M/F 140/57; the median CD4+ cell count was 677 cells/mm3; and HIV RNA at T0 was undetectable in 108 patients. Most of the 197 patients (122, 61.9%) were on a previous INSTI-based regimen. HIV RNA undetectability was more frequent at each follow-up point in patients with HIV RNA that was undetectable at T0, and it showed a higher frequency throughout the follow-up period in patients with always-undetectable HIV RNA in the 12 months before the switch. A higher nadir CD4 cell count had a predictive role, and HBcAb positivity had no influence. In conclusion, the switch could be programmed and possibly delayed on a case-by-case basis in order to achieve persistent plasma HIV RNA undetectability. Undiagnosed loss of HBcAb has no detrimental consequences on the response to BIC/FTC/TAF.
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Affiliation(s)
- Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (M.B.); (F.C.); (N.P.); (F.G.)
| | - Giuliana Battagin
- Infectious Diseases Unit, Vicenza Hospital, 36100 Vicenza, Italy; (G.B.); (S.N.)
| | - Stefano Nicolè
- Infectious Diseases Unit, Vicenza Hospital, 36100 Vicenza, Italy; (G.B.); (S.N.)
| | | | - Francesco Colombo
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (M.B.); (F.C.); (N.P.); (F.G.)
| | - Nicole Pirola
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (M.B.); (F.C.); (N.P.); (F.G.)
| | - Stefano Baratti
- Infectious Diseases Unit, Venezia Hospital, 30122 Venezia, Italy; (S.B.); (S.S.)
| | - Silvia Storato
- Infectious Diseases Unit, Venezia Hospital, 30122 Venezia, Italy; (S.B.); (S.S.)
| | - Federico Giovagnorio
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (M.B.); (F.C.); (N.P.); (F.G.)
| | - Vincenzo Malagnino
- Infectious Disease Unit, Department of System Medicine, Tor Vergata University and Hospital, 00133 Rome, Italy; (V.M.); (G.A.); (L.S.)
| | - Grazia Alessio
- Infectious Disease Unit, Department of System Medicine, Tor Vergata University and Hospital, 00133 Rome, Italy; (V.M.); (G.A.); (L.S.)
| | - Antonio Vinci
- Doctoral School in Nursing Science and Public Health, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Massimo Maurici
- Department of Biomedicine and Prevention, University of Rome “Tor Vergata”, 00133 Rome, Italy;
| | - Loredana Sarmati
- Infectious Disease Unit, Department of System Medicine, Tor Vergata University and Hospital, 00133 Rome, Italy; (V.M.); (G.A.); (L.S.)
| | - Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli, 63, 35100 Padova, Italy; (M.B.); (F.C.); (N.P.); (F.G.)
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Zago D, Pozzetto I, Pacenti M, Brancaccio G, Ragolia S, Basso M, Parisi SG. Circulating Genotypes of Hepatitis C Virus in Italian Patients before and after the Application of Wider Access Criteria to HCV Treatment. Open Microbiol J 2022. [DOI: 10.2174/18742858-v16-e2205300] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023] Open
Abstract
Aims:
The aims of this study were to report a description of the HCV genotype distribution in adult Italians and non-Italians subjects tested in the Microbiology and Virology Unit of the Padova University Hospital from January 2016 (after about one year from the availability of DAAs) to December 2018 and to compare genotype frequencies in the 12-month period before and after the application of the wider access criteria to HCV treatment.
Background:
Hepatitis C virus (HCV) infection is a major health problem, but the availability of direct-acting antivirals (DAAs) has dramatically changed HCV disease natural history because these drugs have excellent tolerability and they can eliminate the virus in almost all treated patients.
Objective:
The objective was to describe the circulating HCV genotypes in high-income countries in order to help health authorities in the future organization of DAAs treatment strategies; this aspect is not limited to drug prescription, but it also includes the identification of infected individuals who are undiagnosed, which is the limiting step to achieve the HCV elimination goal.
Methods:
Adult patients who had HCV genotype performed from 01/01/16 to 31/12/18 in the Microbiology and Virology Unit of the Padova University Hospital were included in the study: the two 12-month periods were April 2016-March 2017 (before period, BEF) and April 2017-March 2018 (after period, AFT).
Results:
Italians were 2168 (91.2%) and non-Italians were 208 (8.8%). Italians median age was 55 years, and females were older. Italians had a lower genotype 1 (p=0.0012) and higher genotype 2 frequencies (p<0.0001) with respect to non-Italians. Most patients aged 38-67 years: Italians were more represented in class age 48-57 years (p=0.0138), 68-77 years (p=0.001) and ≥78 years (p<0.0001); subjects with genotype 3 were the youngest and those with genotype 2 the oldest. Italian patients typed in the AFT and BEF were comparable; only a lower frequency of genotype 1 males and younger age in genotype 3 were found in AFT.
Conclusion:
Italians were older with respect to non-Italians, which implies that a different age based screening program could be applied. Italian genotype 3 subjects represent a cohort to focus on for the risk of therapeutic failure. Patients tested after the extended criteria for HCV treatment were very similar to those tested before, suggesting that HCV burden in Italians is higher than expected.
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Sarinoglu RC, Sili U, Hasdemir U, Aksu B, Soyletir G, Korten V. Diversity of HIV-1 subtypes and transmitted drug-resistance mutations among minority HIV-1 variants in a Turkish cohort. Curr HIV Res 2021; 20:54-62. [PMID: 34802406 DOI: 10.2174/1570162x19666211119111740] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 08/02/2021] [Accepted: 08/13/2021] [Indexed: 11/22/2022]
Abstract
BACKGROUND The World Health Organization (WHO) recommends the surveillance of transmitted drug resistance mutations (TDRMs) to ensure the effectiveness and sustainability of HIV treatment programs. OBJECTIVE Our aim was to determine the TDRMs and evaluate the distribution of HIV-1 subtypes using and compared next-generation sequencing (NGS) and Sanger-based sequencing (SBS) in a cohort of 44 antiretroviral treatment-naïve patients. METHODS All samples that were referred to the microbiology laboratory for HIV drug resistance analysis between December 2016 and February 2018 were included in the study. After exclusions, 44 treatment-naive adult patients with a viral load of >1000 copies/mL were analyzed. DNA sequencing for reverse transcriptase and protease regions was performed using both DeepChek ABL single round kit and Sanger-based ViroSeq HIV-1 Genotyping System. The mutations and HIV-1 subtypes were analyzed using the Stanford HIVdb version 8.6.1 Genotypic Resistance software, and TDRMs were assessed using the WHO surveillance drug-resistance mutation database. HIV-1 subtypes were confirmed by constructing a maximum-likelihood phylogenetic tree using Los Alamos IQ-Tree software. RESULTS NGS identified nucleos(t)ide reverse transcriptase inhibitor (NRTI)-TDRMs in 9.1% of the patients, non-nucleos(t)ide reverse transcriptase inhibitor (NNRTI)-TDRMs in 6.8% of the patients, and protease inhibitor (PI)-TDRMs in 18.2% of the patients at a detection threshold of ≥1%. Using SBS, 2.3% and 6.8% of the patients were found to have NRTI- and NNRTI-TDRMs, respectively, but no major PI mutations were detected. M41L, L74I, K65R, M184V, and M184I related to NRTI, K103N to NNRTI, and N83D, M46I, I84V, V82A, L24I, L90M, I54V to the PI sites were identified using NGS. Most mutations were found in low-abundance (frequency range: 1.0% - 4.7%) HIV-1 variants, except M41L and K103N. The subtypes of the isolates were found as follows; 61.4% subtype B, 18.2% subtype B/CRF02_AG recombinant, 13.6% subtype A, 4.5% CRF43_02G, and 2.3% CRF02_AG. All TDRMs, except K65R, were detected in HIV-1 subtype B isolates. CONCLUSION The high diversity of protease site TDRMs in the minority HIV-1 variants and prevalence of CRFs were remarkable in this study. All minority HIV-1 variants were missed by conventional sequencing. TDRM prevalence among minority variants appears to be decreasing over time at our center.
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Affiliation(s)
- Rabia Can Sarinoglu
- Marmara University School of Medicine, Pendik Training and Research Hospital, Department of Medical Microbiology, Istanbul. Turkey
| | - Uluhan Sili
- Marmara University School of Medicine, Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul. Turkey
| | - Ufuk Hasdemir
- Marmara University School of Medicine, Pendik Training and Research Hospital, Department of Medical Microbiology, Istanbul. Turkey
| | - Burak Aksu
- Marmara University School of Medicine, Pendik Training and Research Hospital, Department of Medical Microbiology, Istanbul. Turkey
| | - Guner Soyletir
- Marmara University School of Medicine, Pendik Training and Research Hospital, Department of Medical Microbiology, Istanbul. Turkey
| | - Volkan Korten
- Marmara University School of Medicine, Pendik Training and Research Hospital, Department of Infectious Diseases and Clinical Microbiology, Istanbul. Turkey
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Macdonald V, Mbuagbaw L, Jordan MR, Mathers B, Jay S, Baggaley R, Verster A, Bertagnolio S. Prevalence of pretreatment HIV drug resistance in key populations: a systematic review and meta-analysis. J Int AIDS Soc 2020; 23:e25656. [PMID: 33369131 PMCID: PMC7758978 DOI: 10.1002/jia2.25656] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 11/10/2020] [Accepted: 11/23/2020] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION WHO's 2019 report on HIV drug resistance (HIVDR) documents a high prevalence of pretreatment drug resistance (PDR) among populations initiating first-line antiretroviral therapy (ART) in low- and middle-income countries (LMIC). However, systematic evidence on the prevalence of PDR among key populations remains limited. We performed a systematic review to characterize levels of PDR in key population groups and compared them to levels of PDR in the "general population" across different geographical regions. METHODS Ten electronic databases were searched for papers published until February 2019 that included predefined search terms. We included studies that reported the number of successfully tested genotypes and the number of genotypes with drug resistance mutations among antiretroviral therapy treatment naïve people, recently infected people, or people initiating first-line ART from key populations. To assess the prevalence of PDR for each key population, we pooled estimates using random-effects meta-analysis of proportions. Where possible, we computed the differences in the odds of PDR (any, and by drug class) present in each key population compared to the "general population". The I2 statistic (a measure of heterogeneity between studies) is reported. RESULTS AND DISCUSSION A total of 332 datasets (from 218 studies) and 63,111 people with successful HIVDR genotyping were included in the analysis. The pooled prevalence estimate of any PDR was high among men who have sex with men (13.0%, 95% CI 11.0 to 14.0%, I2 = 93.19), sex workers (17.0%, 95% CI 6.0 - 32.0, I2 = 87.31%) and people in prisons (18.0%, 95% CI 11.0 to 25.0, I2 = 70.18%), but less so among people who inject drugs (7.0%, 95% CI 5.0 to 10.0, I2 = 90.23). Overall, men who have sex with men were more likely to carry any PDR compared to the "general population," a finding which was statistically significant (odds ratio (OR) 1.28, 95% CI 1.13 - 1.46, I2 48.9%). CONCLUSIONS High prevalence of PDR found in key populations highlights the need to increase access to effective first-line HIV treatment. The low prevalence of nucleotide reverse transcriptase inhibitor (NRTI) PDR suggests that current WHO recommendations for pre-exposure prophylaxis (PrEP) regimens will remain effective and can be scaled up to prevent new HIV infections in high-risk groups.
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Affiliation(s)
- Virginia Macdonald
- Department of HIV, Hepatitis, and Sexually Transmitted DiseasesWorld Health OrganizationGenevaSwitzerland
| | - Lawrence Mbuagbaw
- Department of Health Research Methods, Evidence and ImpactMcMaster UniversityHamiltonONCanada
- Biostatistics UnitFather Sean O’Sullivan Research CentreSt Joseph’s Healthcare‐HamiltonHamiltonONCanada
| | - Michael R Jordan
- Division of Geographic MedicineTufts Medical CenterBostonMAUSA
- Department of Public Health and Community MedicineTufts University School of MedicineBostonMAUSA
- Tufts Center for Integrated Management of Antimicrobial Resistance (CIMAR)BostonMAUSA
- Levy Center for Integrated Management of Antimicrobial Resistance (CIMAR)BostonMAUSA
| | - Bradley Mathers
- Department of HIV, Hepatitis, and Sexually Transmitted DiseasesWorld Health OrganizationGenevaSwitzerland
| | - Sharon Jay
- Department of HIV, Hepatitis, and Sexually Transmitted DiseasesWorld Health OrganizationGenevaSwitzerland
| | - Rachel Baggaley
- Department of HIV, Hepatitis, and Sexually Transmitted DiseasesWorld Health OrganizationGenevaSwitzerland
| | - Annette Verster
- Department of HIV, Hepatitis, and Sexually Transmitted DiseasesWorld Health OrganizationGenevaSwitzerland
| | - Silvia Bertagnolio
- Department of HIV, Hepatitis, and Sexually Transmitted DiseasesWorld Health OrganizationGenevaSwitzerland
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9
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Celotti A, Gargiulo F, Quiros-Roldan E, Properzi M, De Francesco MAD, Coletto D, Caccuri F, Izzo I, Caruso A, Castelli F, Focà E. Presence of V72I, G123S and R127K Integrase Inhibitor polymorphisms could reduce ART effectiveness: a retrospective longitudinal study. HIV Res Clin Pract 2020; 21:24-33. [PMID: 32141388 DOI: 10.1080/25787489.2020.1734753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Objectives: Structural aspects of HIV-1 integrase complex and role of integrase minor mutations and polymorphisms in ART effectiveness is still unknown. The objective of this study was to assess the 24 and 48 weeks (W) effectiveness of ART regimens in patients with Integrase Inhibitors (InSTI) minor mutations and polymorphisms receiving InSTI-based regimens.Methods: We enrolled all ART-naïve or InSTI-naïve HIV-infected patients, with a baseline InSTI genotypic resistances test between 2011 and 2016. We analyzed integrase resistance mutations using the Stanford University HIV Drug Resistance Database (HIVdb Program, version 6.3.0). The outcome was virological response at 24 and 48 W of follow up (FU) according to snapshot analysis. We defined virological failure as two consecutive HIV-RNA > 50 copies/ml, or one >1000 copies/ml. Patients were divided in those presenting InSTI minor mutations (Group 1), and those with only polymorphisms or wild type (Group 2).Results: We enrolled 83 patients. 81 patients reached 24 W of FU: 2/20 (10%) and 4/61 (6.5%) showed virological failure in Group 1 and 2 respectively. 66 patients reached 48 W of FU: 0/17 (0%) and 2/49 (4%) showed virological failure in Group 1 and 2 respectively. Interestingly, patients with polymorphisms G123S and R127K had higher risk of failure at 24 W (respectively, relative risk - RR - 36, IQR 2.1-613, p = 0.01; RR 36, IQR 2.1-613, p = 0.01) and patients with V72I had an higher risk of failure both at 24 W (RR 6.52, IQR 1.29-32.9, p = 0.02) and 48 W (RR 21.1, IQR 1.07-414, p = 0.04).Conclusions: Our study showed that the presence of V72I, G123S and R127K polymorphisms could play a role in reducing InSTI effectiveness.
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Affiliation(s)
- Anna Celotti
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Franco Gargiulo
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Eugenia Quiros-Roldan
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Martina Properzi
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Maria Antonia De De Francesco
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Davide Coletto
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Francesca Caccuri
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Ilaria Izzo
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Arnaldo Caruso
- Institute of Microbiology, Department of Molecular and Translational Medicine, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Francesco Castelli
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
| | - Emanuele Focà
- Department of Infectious and Tropical Diseases, University of Brescia and ASST Spedali Civili Hospital, Brescia, Italy
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10
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Bavaro DF, Di Carlo D, Rossetti B, Bruzzone B, Vicenti I, Pontali E, Zoncada A, Lombardi F, Di Giambenedetto S, Borghi V, Pecorari M, Milini P, Meraviglia P, Monno L, Saracino A. Pretreatment HIV drug resistance and treatment failure in non-Italian HIV-1-infected patients enrolled in ARCA. Antivir Ther 2020; 25:61-71. [PMID: 32118584 DOI: 10.3851/imp3349] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND An increase in pretreatment drug resistance (PDR) to first-line antiretroviral therapy (ART) in low-income countries has been recently described. Herein we analyse the prevalence of PDR and risk of virological failure (VF) over time among migrants to Italy enrolled in ARCA. METHODS HIV-1 sequences from ART-naive patients of non-Italian nationality were retrieved from ARCA database from 1998 to 2017. PDR was defined by at least one mutation from the reference 2009 WHO surveillance list. RESULTS Protease/reverse transcriptase sequences from 1,155 patients, mainly migrants from sub-Saharan Africa (SSA; 42%), followed by Latin America (LA; 25%) and Western countries (WE; 21%), were included. PDR was detected in 8.6% of sequences (13.1% versus 5.8% for B and non-B strains, respectively; P<0.001). 2.1% of patients carried a PDR for protease inhibitors (PIs; 2.1% versus 2.3%; P=0.893), 3.9% for nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs; 6.8% versus 2.1%; P<0.001) and 4.3% for non-nucleoside/nucleotide reverse transcriptase inhibitors (NNRTIs; 6.3% versus 3.1%; P=0.013). Overall, prevalence of PDR over the years remained stable, while it decreased for PIs in LA (P=0.021) and for NRTIs (P=0.020) among migrants from WE. Having more than one class of PDR (P=0.015 versus absence of PDR), higher viral load at diagnosis (P=0.008) and being migrants from SSA (P=0.001 versus WE) were predictive of VF, while a recent calendar year of diagnosis (P<0.001) was protective for VF. CONCLUSIONS PDR appeared to be stable over the years in migrants to Italy enrolled in ARCA; however, it still remains an important cause of VF together with viral load at diagnosis.
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Affiliation(s)
- Davide Fiore Bavaro
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari Medical School, Bari, Italy.,These authors equally contributed to this work
| | - Domenico Di Carlo
- Pediatric Clinical Research Center 'Romeo and Enrica Invernizzi', University of Milan, Milan, Italy.,These authors equally contributed to this work
| | - Barbara Rossetti
- Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | | | - Ilaria Vicenti
- Dipartimento di Biotecnologie Mediche, Università di Siena, Siena, Italy
| | | | | | - Francesca Lombardi
- Università Cattolica del Sacro Cuore, Roma Italia, Istituto di Clinica Malattie Infettive, Rome, Italy
| | - Simona Di Giambenedetto
- Università Cattolica del Sacro Cuore, Roma Italia, Istituto di Clinica Malattie Infettive, Rome, Italy.,Fondazione Policlinico Universitario A. Gemelli IRCCS, Roma Italia, UOC malattie infettive, Rome, Italy
| | - Vanni Borghi
- Clinica Malattie infettive, Azienda Ospedaliero Universitaria di Modena, Modena, Italy
| | - Monica Pecorari
- SSD Virologia, Azienda Ospedaliero-Univeristaria Policlinico Modena, Modena, Italy
| | - Paola Milini
- Infectious Diseases Unit, Macerata Hospital, Macerata, Italy
| | - Paola Meraviglia
- 1st Division of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Laura Monno
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari Medical School, Bari, Italy
| | - Annalisa Saracino
- Department of Biomedical Sciences and Human Oncology, Clinic of Infectious Diseases, University of Bari Medical School, Bari, Italy
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11
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Analysis of HIV-1 diversity, primary drug resistance and transmission networks in Croatia. Sci Rep 2019; 9:17307. [PMID: 31754119 PMCID: PMC6872562 DOI: 10.1038/s41598-019-53520-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 10/31/2019] [Indexed: 01/23/2023] Open
Abstract
Molecular epidemiology of HIV-1 infection in treatment-naive HIV-1 infected persons from Croatia was investigated. We included 403 persons, representing 92.4% of all HIV-positive individuals entering clinical care in Croatia in 2014–2017. Overall prevalence of transmitted drug resistance (TDR) was estimated at 16.4%. Resistance to nucleoside reverse transcriptase inhibitors (NRTIs), non-nucleoside RTI (NNRTIs) and protease inhibitors (PIs) was found in 11.4%, 6.7% and 2.5% of persons, respectively. Triple-class resistance was determined in 2.2% of individuals. In addition, a single case (1.0%) of resistance to integrase strand-transfer inhibitors (InSTIs) was found. Deep sequencing was performed on 48 randomly selected samples and detected additional TDR mutations in 6 cases. Phylogenetic inference showed that 347/403 sequences (86.1%) were part of transmission clusters and identified forward transmission of resistance in Croatia, even that of triple-class resistance. The largest TDR cluster of 53 persons with T215S was estimated to originate in the year 1992. Our data show a continuing need for pre-treatment HIV resistance testing in Croatia. Even though a low prevalence of resistance to InSTI was observed, surveillance of TDR to InSTI should be continued.
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12
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Mazzuti L, Melengu T, Falasca F, Calabretto M, Cella E, Ciccozzi M, Mezzaroma I, Iaiani G, Spaziante M, d'Ettorre G, Fimiani C, Vullo V, Antonelli G, Turriziani O. Transmitted drug resistance mutations and trends of HIV-1 subtypes in treatment-naïve patients: A single-centre experience. J Glob Antimicrob Resist 2019; 20:298-303. [PMID: 31518723 DOI: 10.1016/j.jgar.2019.08.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 07/12/2019] [Accepted: 08/28/2019] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES Transmitted drug resistance (TDR) and HIV-1 genetic diversity may affect treatment efficacy and clinical outcomes. Here we describe the circulating viral subtypes and estimate the prevalence of drug resistance among antiretroviral therapy (ART)-naïve patients attending Sapienza University Hospital (Rome, Italy) from 2006-2017. METHODS Genotypic resistance testing (GRT) was performed on 668 ART-naïve patients for integrase (n = 52), protease and reverse transcriptase (n = 668) sequences. RESULTS Twenty-one different HIV-1 subtypes and circulating recombinant forms (CRFs) were identified. Subtype B was the most common (67.1%), followed by CRF02_AG (8.4%), and subtypes C and F (both 6.0%). A significantly increase in the proportion of non-B strains (P < 0.001) and the rate of non-Italian patients was observed over time. The overall prevalence of TDR was 9.4% (NRTI, 4.2%; NNRTI, 5.8%; and PI, 1.0%) and was higher in subtype B strains. Transmitted INSTI mutations (Q148H and G140S) responsible for high-level resistance to raltegravir and elvitegravir and intermediate resistance to dolutegravir and bictegravir were found, for the first time, in two individuals. Minor or accessory INSTI mutations were detected in 17.3% of patients. No significant decrease in the prevalence of TDR was documented over time. CONCLUSION The significant increase in non-B subtypes suggests that the molecular epidemiology of HIV-1 is changing. Detection of a major INSTI mutation in two ART-naïve patients highlights the importance of performing GRT before commencing treatment. This finding and the lack of a significant reduction in TDRs underline the importance of continuous surveillance of resistance mutations.
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Affiliation(s)
- Laura Mazzuti
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Taulant Melengu
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | - Francesca Falasca
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
| | | | - Eleonora Cella
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Massimo Ciccozzi
- Unit of Medical Statistics and Molecular Epidemiology, University Campus Bio-Medico of Rome, Rome, Italy
| | - Ivano Mezzaroma
- Department of Translational and Precision Medicine, Department of Public Health and Infectious Diseases, Sapienza University of Rome, Rome, Italy
| | | | - Martina Spaziante
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Gabriella d'Ettorre
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | | | - Vincenzo Vullo
- Department of Public Health and Infectious Diseases, 'Sapienza' University of Rome, Rome, Italy
| | - Guido Antonelli
- Department of Molecular Medicine, Sapienza University of Rome, Rome, Italy
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13
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Budayanti NS, Merati TP, Bela B, Mahardika GN. Molecular Antiretroviral Resistance Markers of Human Immunodeficiency Virus-1 of CRF01_AE Subtype in Bali, Indonesia. Curr HIV Res 2019; 16:374-382. [PMID: 30714528 PMCID: PMC6446452 DOI: 10.2174/1570162x17666190204101154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2018] [Revised: 01/27/2019] [Accepted: 01/30/2019] [Indexed: 11/22/2022]
Abstract
Background: Molecular epidemiological study of human immunodeficiency virus drug-resistant (HIVDR) markers is challenging in areas where the dominant subtype is non-B. Objective: Here we provide molecular data for HIVDR in the CRF01_AE subtype in Bali, Indonesia. Method: Seventy patients were enrolled in this study and grouped into treatment failure and treatment naïve groups. The full-length pol gene was amplified using nested reverse transcriptase polymerase chain reaction and the product was then sequenced. The readable sequence was then subjected to Stan-ford HIV Drug Resistance Database genotyping. Results: We found that clinical classification was in accordance with the presence of HIVDR markers in the pol gene. Independent of therapy history, the treatment failure group showed resistance markers against nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase in-hibitors (NNRTI), ranging from 72%–100% of patients. Only a small proportion of naïve patients harbored HIV with drug resistance markers to NNRTI. No protease inhibitor-resistant marker was found in either patient group. Molecular marker mutations, which were found in more than 50% of treatment failure patients, were M184V (100%), T215A/Y/F (88.2%), D67N/G (76.5%), and M41L (58.8%). Conclusion: The protocol used in this study to determine genetic markers of HIVDR based on sub-type B can be applied for the rapid determination of resistance of the CRF01_AE subtype. All patients with progressive clinical signs and increased viral load should be recommended to undergo second-line treatment of the ARV regimen.
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Affiliation(s)
- Nyoman Sri Budayanti
- Microbiology Department, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - Tuti Parwati Merati
- Internal Medicine Department, Faculty of Medicine, Udayana University, Jl. PB Sudirman, Denpasar, Bali, Indonesia
| | - Budiman Bela
- Microbiology Department, Faculty of Medicine, Indonesia University, Jakarta, Indonesia
| | - Gusti Ngurah Mahardika
- Animal Biomedical and Molecular Biology Laboratory, Faculty of Veterinary Medicine, Udayana University, Jl. Sesetan-Markisa 6, Denpasar 80226, Bali, Indonesia
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14
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Parisi SG, Basso M, Scaggiante R, Andreis S, Mengoli C, Cruciani M, Del Vecchio C, Menegotto N, Zago D, Sarmati L, Andreoni M, Palù G. Oral and anal high-risk human papilloma virus infection in HIV-positive men who have sex with men over a 24-month longitudinal study: complexity and vaccine implications. BMC Public Health 2019; 19:645. [PMID: 31138232 PMCID: PMC6537447 DOI: 10.1186/s12889-019-7004-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 05/17/2019] [Indexed: 01/06/2023] Open
Abstract
Background Few studies focused on longitudinal modifications over time of high-risk HPV (HR-HPV) at anal and oral sites in HIV+ men who have sex with men (MSM). Methods We described patterns and longitudinal changes of HR-HPV detection and the prevalence of HR-HPV covered by the nonavalent HPV vaccine (vax-HPV) at oral and anal sites in 165 HIV+ MSM followed in an Italian hospital. The samples were collected at baseline and after 24 months (follow-up). The presence of HPV was investigated with Inno-LiPA HPV Genotyping Extra II. Results Median age was 44 years (IQR 36–53), median CD4+ cell count at nadir was 312 cells/mm3 (IQR 187–450). A total of 120 subjects (72.7%) were receiving successful antiretroviral therapy (ART). At baseline and follow-up, the frequency of HR-HPV was significantly higher in the anal site (65.4% vs 9.4 and 62.4% vs 6.8%, respectively). Only 2.9% of subjects were persistently HR-HPV negative at both sites. All oral HR-HPV were single at baseline vs 54.6% at baseline at the anal site (p = 0.005), and all oral HR-HPV were single at follow-up vs 54.4% at anal site at follow-up (p = 0.002). The lowest rate of concordance between the oral and anal results was found for HR-HPV detection; almost all HR-HPV positive results at both anal and oral sites had different HR-HPV.The most frequent HR-HPV in anal swabs at baseline and follow-up were HPV-16 and HPV-52.At follow-up at anal site, 37.5% of patients had different HR-HPV genotypes respect to baseline, 28.8% of subjects with 1 HR-HPV at baseline had an increased number of HR-HPV, and patients on ART showed a lower frequency of confirmed anal HR-HPV detection than untreated patients (p = 0.03) over time. Additionally,54.6 and 50.5% of patients had only HR-vax-HPV at anal site at baseline and follow-up, respectively; 15.2% had only HR-vax-HPV at baseline and follow-up. Conclusions We believe that it is important testing multiple sites over time in HIV-positive MSM. ART seems to protect men from anal HR-HPV confirmed detection. Vaccination programmes could reduce the number of HR-HPV genotypes at anal site and the risk of the first HR-HPV acquisition at the oral site. Electronic supplementary material The online version of this article (10.1186/s12889-019-7004-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Saverio Giuseppe Parisi
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy.
| | - Monica Basso
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy.
| | - Renzo Scaggiante
- Infectious Diseases Unit, Padova Hospital, Via Giustiniani, 2 -, 35128, Padova, Italy
| | - Samantha Andreis
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy
| | - Carlo Mengoli
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy
| | - Mario Cruciani
- Center of Diffusive Diseases, ULSS 9, Via Campania 1, 37136, Verona, Italy
| | - Claudia Del Vecchio
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy
| | - Nicola Menegotto
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy
| | - Daniela Zago
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy
| | - Loredana Sarmati
- Clinical Infectious Diseases, Tor Vergata University, Viale Oxford, 81, 00133, Rome, Italy
| | - Massimo Andreoni
- Clinical Infectious Diseases, Tor Vergata University, Viale Oxford, 81, 00133, Rome, Italy
| | - Giorgio Palù
- Department of Molecular Medicine, University of Padova, Via Gabelli 63, 35100, Padova, Italy
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15
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Alvarez M, Casas P, de Salazar A, Chueca N, Guerrero-Beltran C, Rodríguez C, Imaz A, Espinosa N, García-Bujalance S, Pérez-Elías MJ, García-Alvarez M, Iribarren JA, Santos J, Dalmau D, Aguilera A, Vinuesa D, Gutiérrez F, Piérola B, Molina JM, Peraire J, Portilla I, Gómez-Sirvent JL, Olalla J, Galera C, Blanco JR, Riera M, García-Fraile L, Navarro G, Curran A, Poveda E, García F, Moreno S, Jarrín I, Dalmau D, Navarro ML, González MI, Blanco JL, Garcia F, Rubio R, Iribarren JA, Gutiérrez F, Vidal F, Berenguer J, González J, Alejos B, Hernando V, Moreno C, Iniesta C, Sousa LMG, Perez NS, Muñoz-Fernández MÁ, García-Merino IM, Fernández IC, Rico CG, de la Fuente JG, Concejo PP. Surveillance of transmitted drug resistance to integrase inhibitors in Spain: implications for clinical practice. J Antimicrob Chemother 2019; 74:1693-1700. [DOI: 10.1093/jac/dkz067] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2018] [Revised: 01/17/2019] [Accepted: 01/24/2019] [Indexed: 12/20/2022] Open
Affiliation(s)
- Marta Alvarez
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Paz Casas
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Adolfo de Salazar
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Natalia Chueca
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | - Carlos Guerrero-Beltran
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
| | | | - Arkaitz Imaz
- Unidad de VIH e ITS, Departamento de Enfermedades Infecciosas, Hospital Universitari de Bellvitge-IDIBELL, L’Hospitalet de Llobregat, Barcelona, Spain
| | - Nuria Espinosa
- Unidad de Enfermedades Infecciosas, Hospital Virgen del Rocio, Sevilla, Spain
| | | | | | - Mónica García-Alvarez
- Unidad de Microbiología Clínica, Hospital Universitario Doce de Octubre, Madrid, Spain
| | - Jose Antonio Iribarren
- Unidad de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto BioDonostia, Donostia, Spain
| | - Jesús Santos
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - David Dalmau
- Unidad de Enfermedades Infecciosas, Hospital Universitario Mutua Terrasa, Terrasa, Spain
| | - Antonio Aguilera
- Servicio y Departamento de Microbiología, Complejo Hospitalario Universitario de Santiago y Universidad de Santiago de Compostela, Santiago de Compostela, Spain
| | - David Vinuesa
- Unidad de Enfermedades Infecciosas, Hospital Universitario, Universitario San Cecilio, Granada, Spain
| | - Félix Gutiérrez
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Elche & Universidad Miguel Hernández, Alicante, Spain
| | - Beatriz Piérola
- Unidad de Enfermedades Infecciosas, Complejo Hospitalario de Navarra, Pamplona, Spain
| | - José Miguel Molina
- Unidad de Microbiología Clínica, Hospital Universitario La Fe, Valencia, Spain
| | - Joaquim Peraire
- Unidad de Enfermedades Infecciosas, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain
| | - Irene Portilla
- Unidad de Enfermedades Infecciosas, Hospital Universitario Alicante, Alicante, Spain
| | - Juan Luis Gómez-Sirvent
- Unidad de Enfermedades Infecciosas, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain
| | - Julián Olalla
- Unidad de Enfermedades Infecciosas, Hospital Costa del Sol, Marbella, Spain
| | - Carlos Galera
- Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain
| | - José Ramón Blanco
- Unidad de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, Spain
| | - Melchor Riera
- Unidad de Enfermedades Infecciosas, Hospital Universitario Son Espases, Palma de Mallorca, Spain
| | - Lucio García-Fraile
- Unidad de Enfermedades Infecciosas, Hospital Universitario La Princesa, Madrid, Spain
| | - Gemma Navarro
- Unidad de Enfermedades Infecciosas, Hospital Universitario Parc Taulí, Sabadell, Spain
| | - Adrían Curran
- Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d´Hebron, Barcelona, Spain
| | - Eva Poveda
- Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain
| | - Federico García
- Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain
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16
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Rossetti B, Di Giambenedetto S, Torti C, Postorino MC, Punzi G, Saladini F, Gennari W, Borghi V, Monno L, Pignataro AR, Polilli E, Colafigli M, Poggi A, Tini S, Zazzi M, De Luca A. Evolution of transmitted HIV-1 drug resistance and viral subtypes circulation in Italy from 2006 to 2016. HIV Med 2018; 19:619-628. [PMID: 29932313 DOI: 10.1111/hiv.12640] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/08/2018] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The aim was to evaluate the evolution of transmitted HIV-1 drug resistance (TDR) prevalence in antiretroviral therapy (ART)-naïve patients from 2006 to 2016. METHODS HIV-1 sequences were retrieved from the Antiviral Response Cohort Analysis (ARCA) database and TDR was defined as detection of at least one mutation from the World Health Organization (WHO) surveillance list. RESULTS We included protease/reverse transcriptase sequences from 3573 patients; 455 had also integrase sequences. Overall, 68.1% of the patients were Italian, the median CD4 count was 348 cells/μL [interquartile range (IQR) 169-521 cells/μL], and the median viral load was 4.7 log10 HIV-1 RNA copies/mL (IQR 4.1-5.3 log10 copies/mL). TDR was detected in 10.3% of patients: 6% carried mutations to nucleos(t)ide reverse transcriptase inhibitors (NRTIs), 4.4% to nonnucleos(t)ide reverse transcriptase inhibitors (NNRTIs), 2.3% to protease inhibitors (PIs), 0.2% to integrase strand transfer inhibitors (INSTIs) and 2.1% to at least two drug classes. TDR declined from 14.5% in 2006 to 7.3% in 2016 (P = 0.003): TDR to NRTIs from 9.9 to 2.9% (P = 0.003) and TDR to NNRTIs from 5.1 to 3.7% (P = 0.028); PI TDR remained stable. The proportion carrying subtype B virus declined from 76.5 to 50% (P < 0.001). The prevalence of TDR was higher in subtype B vs. non-B (12.6 vs. 4.9%, respectively; P < 0.001) and declined significantly in subtype B (from 17.1 to 8.8%; P = 0.04) but not in non-B subtypes (from 6.1 to 5.8%; P = 0.44). Adjusting for country of origin, predictors of TDR were subtype B [adjusted odds ratio (AOR) for subtype B vs. non-B 2.91; 95% confidence interval (CI) 1.93-4.39; P < 0.001], lower viral load (per log10 higher: AOR 0.86; 95% CI 0.75-0.99; P = 0.03), site in northern Italy (AOR for southern Italy/island vs. northern Italy, 0.61; 95% CI 0.40-0.91; P = 0.01), and earlier calendar year (per 1 year more recent: AOR 0.95; 95% CI 0.91-0.99; P = 0.02). CONCLUSIONS The prevalence of HIV-1 TDR has declined during the last 10 years in Italy.
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Affiliation(s)
- B Rossetti
- Infectious Diseases Unit, University Hospital of Siena, Siena, Italy
| | - S Di Giambenedetto
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - C Torti
- Infectious Diseases Unit, Catanzaro, Italy
| | | | - G Punzi
- Virology, Bari Hospital, Bari, Italy
| | - F Saladini
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - W Gennari
- Virology, Modena Hospital, Modena, Italy
| | - V Borghi
- Infectious Diseases Unit, Modena Hospital, Modena, Italy
| | - L Monno
- Infectious Diseases Unit, Bari Hospital, Bari, Italy
| | | | - E Polilli
- Virology, Pescara Hospital, Pescara, Italy
| | - M Colafigli
- Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy
| | - A Poggi
- Infectious Diseases Unit, S. Maria Annunziata Hospital, Firenze, Italy
| | - S Tini
- Medicine Department, Città di Castello, Italy
| | - M Zazzi
- Department of Medical Biotechnologies, University of Siena, Siena, Italy
| | - A De Luca
- Infectious Diseases Unit, University Hospital of Siena, Siena, Italy.,Department of Medical Biotechnologies, University of Siena, Siena, Italy
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Lunar MM, Židovec Lepej S, Tomažič J, Vovko TD, Pečavar B, Turel G, Maver M, Poljak M. HIV-1 transmitted drug resistance in Slovenia and its impact on predicted treatment effectiveness: 2011-2016 update. PLoS One 2018; 13:e0196670. [PMID: 29698470 PMCID: PMC5919638 DOI: 10.1371/journal.pone.0196670] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2018] [Accepted: 04/17/2018] [Indexed: 01/30/2023] Open
Abstract
HIV-positive individuals that have a detected transmitted drug resistance (TDR) at baseline have a higher risk of virological failure with antiretroviral therapy (ART). This study offers an update on the prevalence of TDR in Slovenia, looks for onward transmission of TDR, and reassesses the need for baseline drug resistance testing. Blinded questionnaires and partial pol sequences were obtained from 54.5% (168/308) of all of the patients diagnosed with HIV-1 from 2011 to 2016. Subtype B was detected in 82.7% (139/168) of patients, followed by subtype A (8.3%), subtype C (2.4%), and CRF01_AE (1.8%). Surveillance drug resistance mutations (SDRMs) were found in four individuals (2.4%), all of them men who have sex with men (MSM) and infected with subtype B. K103N was detected in two patients and T68D and T215D in one person each, corresponding to a prevalence of 0%, 1.2%, and 1.2% of TDR to protease inhibitors (PIs), nucleoside reverse transcriptase inhibitors (NRTIs), and non-NRTIs (NNRTIs), respectively. The impact of mutations on drug susceptibility was found to be most pronounced for NNRTIs. No forward spread of TDR within the country was observed; however, phylogenetic analysis revealed several new introductions of HIV into Slovenia in recent years, possibly due to increased risky behavior by MSM. This was indirectly confirmed by a substantial increase in syphilis cases and HIV-1 non-B subtypes during the study period. A drug-resistant HIV variant with good transmission fitness is thus more likely to be imported into Slovenia in the near future, and so TDR should be closely monitored.
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Affiliation(s)
- Maja M. Lunar
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
| | | | - Janez Tomažič
- Department of Infectious Diseases, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Tomaž D. Vovko
- Department of Infectious Diseases, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Blaž Pečavar
- Department of Infectious Diseases, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Gabriele Turel
- Department of Infectious Diseases, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Manja Maver
- Department of Infectious Diseases, Ljubljana University Medical Center, Ljubljana, Slovenia
| | - Mario Poljak
- Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia
- * E-mail:
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