Brazilian network for HIV Drug Resistance Surveillance (HIV‐BresNet): a survey of treatment‐naive individuals

Introduction In Brazil, more than 487,450 individuals are currently undergoing antiretroviral treatment. In order to monitor the transmission of drug‐resistant strains and HIV subtype distribution in the country, this work aimed to estimate its prevalence and to characterize the nationwide pretreatm...

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Published in:	Journal of the International AIDS Society Vol. 21; no. 3; pp. 1 - n/a
Main Authors:	Arruda, Monica B, Boullosa, Lídia T, Cardoso, Cynthia C, Costa, Carolina M, Brites, Carlos, Lima, Shirlene TS, Kaminski, Helena T, Aleixo, Agdemir W, Esposito, Ana OP, Cavalcanti, Ana MS, Riedel, Maristela, Couto‐Fernandez, José C, Ferreira, Selma B, Oliveira, Ivi CM, Portal, Loreci E, Wolf, Hilda HC, Fernandes, Sandra B, M. C. Pardini, Maria I, Feiteiro, Manoel VC, Tolentino, Fernanda M, Diaz, Ricardo S, Lopes, Giselle ISL, Francisco, Roberta BL, Véras, Nazle MC, Pires, Ana F, Franchini, Miriam, Mesquita, Fábio, Tanuri, Amilcar, Melo Xavier Shimizu, Andrea, Jorge, Célia Regina Mayoral Pedroso, Mello, Leda Maria Simões, Freitas, Eider Gurgel, Tupinambás, Unaí, Barros Rosa Costa, Dijane Cristina, Silva, Sirleide Pereira, Graça Winhescki, Maria, Jesus, Carlos Silva, Santos Nascimento, Érica Ramos, Oliveira Prazim, Fatima Ercília, Rosa, Marilda Tereza Mar, Salvador, Karina, Alcântara Belettini, Senele Ana, Grotto, Rejane Maria Tommasini, Oliveira, Paulo Henrique, Gomes, Érica Valessa Ramos, Dias, Danilo Araujo, Galinskas, Juliana, Campos, Norberto Camilo, Neto, José Boullosa Alonso
Format:	Journal Article
Language:	English
Published:	Switzerland John Wiley & Sons, Inc 01-03-2018 International AIDS Society John Wiley and Sons Inc
Subjects:	Acquired immune deficiency syndrome Adult AIDS Anti-HIV Agents - therapeutic use Antiretroviral drugs antiretroviral resistance Brazil Care and treatment Diagnosis Drug resistance Drug Resistance, Viral - genetics Drug therapy Female Genotype HIV HIV drug resistance HIV Drug Resistance Surveillance HIV infections HIV Infections - drug therapy HIV patients Human immunodeficiency virus Humans Male Middle Aged Mutation pretreatment HIV drug resistance primary antiretroviral resistance Reverse Transcriptase Inhibitors - therapeutic use Risk factors Surveys Brazil United States > US pretreatment HIV drug resistance primary antiretroviral resistance HIV Drug Resistance Surveillance antiretroviral resistance HIV HIV drug resistance
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Summary:	Introduction In Brazil, more than 487,450 individuals are currently undergoing antiretroviral treatment. In order to monitor the transmission of drug‐resistant strains and HIV subtype distribution in the country, this work aimed to estimate its prevalence and to characterize the nationwide pretreatment drug resistance in individuals recently diagnosed with HIV between 2013 and 2015. Methods The HIV threshold survey methodology (HIV‐THS, WHO) targeting antiretroviral‐naive individuals with recent HIV diagnosis was utilized, and subjects were selected from 51 highly populated cities in all five Brazilian macroregions. The HIV pol genotypic test was performed by genomic sequencing. Results We analysed samples from 1568 antiretroviral‐naive individuals recently diagnosed with HIV, and the overall transmitted drug resistance (TDR) prevalence was 9.5% (150 sequences). The regional prevalence of resistance according to Brazilian geographical regions was 9.4% in the northeast, 11.2% in the southeast, 6.8% in the central region, 10.2% in the north and 8.8% in the south. The inhibitor‐specific TDR prevalence was 3.6% for nucleoside reverse transcriptase inhibitors (NRTIs), 5.8% for non‐nucleoside reverse transcriptase inhibitors (NNRTIs) and 1.6% for protease inhibitors (PIs); 1.0% of individuals presented resistance to more than one class of inhibitors. Overall, subtype B was more prevalent in every region except for the southern, where subtype C prevails. Conclusions To the best of our knowledge, this is the first TDR study conducted in Brazil with nationwide representative sampling. The TDR prevalence revealed a moderate rate in the five Brazilian geographical regions, although some cities presented higher TDR prevalence rates, reaching 14% in São Paulo, for example. These results further illustrate the importance of surveillance studies for designing future strategies in primary antiretroviral therapy, aiming to mitigate TDR, as well as for predicting future trends in other regions of the globe where mass antiretroviral (ARV) treatment was implemented.
Bibliography:	Correction note: The name of the fifth author was corrected on 8 May 2018. ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 See the Appendix for members of HIV‐BResNet. All authors cited in the HIV‐BResNet group collaborated equally in the article.
ISSN:	1758-2652 1758-2652
DOI:	10.1002/jia2.25032