National survey of pre-treatment HIV drug resistance in Cuban patients

• Published in: PloS one Vol. 14; no. 9; p. e0221879
• Main Authors: Machado, Liuber Y, Blanco, Madeline, López, Laura S, Díaz, Héctor M, Dubed, Marta, Valdés, Neisy, Noa, Enrique, Martínez, Liodelvio, Pérez, María T, Romay, Dania M, Rivero, Caridad B, Joanes, José, Cancio, Isis, Lantero, María I, Rodríguez, Mireida
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 03-09-2019; Public Library of Science (PLoS)
• Subjects: Acquired immune deficiency syndrome; Adolescent; Adult; Adults; Aged; AIDS; Anti-HIV agents; Anti-HIV Agents - therapeutic use; Antimicrobial agents; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiretroviral Therapy, Highly Active; Biology and Life Sciences; Care and treatment; CD4 antigen; Cross-Sectional Studies; Cuba - epidemiology; DNA polymerases; Drug resistance; Drug Resistance, Viral - genetics; EDTA; Epidemiology; Female; Genes, pol; Genetic diversity; Genetic variance; Health; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; HIV-1 - classification; HIV-1 - drug effects; HIV-1 - genetics; Human immunodeficiency virus; Humans; Male; Medical research; Medicine and Health Sciences; Men; Middle Aged; Municipalities; Mutation; Nucleoside reverse transcriptase inhibitors; Nucleosides; Patients; People and places; Phylogeny; Prevalence; Protease inhibitors; Proteases; Proteinase inhibitors; Public health; Research and Analysis Methods; RNA-directed DNA polymerase; Sex; Sexually transmitted diseases; STD; Young Adult; Cuba; United States > US; Switzerland
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0221879

The World Health Organization (WHO) recommends a method to estimate nationally representative pretreatment HIV drug resistance (PDR) in order to evaluate the effectiveness of first -line treatments. The objective of the present study was to determine the prevalence of PDR in Cuban adults infected with HIV-1.
A cross-sectional study in Cuban adults infected with HIV-1 over 18 years was conducted. The probability proportional to size method for the selection of municipalities and patients without a prior history of antiretroviral treatment during the period from January 2017 to June 2017 was used. The plasma from 141 patients from 15 municipalities for the determination of viral subtype and HIV drug resistance was collected. Some clinical and epidemiological variables were evaluated.
80. 9% of the patients corresponded to the male sex and 76.3% were men who have sex with other men (MSM). The median CD4 count was 371 cells / mm3 and the median viral load was 68000 copies / mL. The predominant genetic variants were subtype B (26.9%), CRF19_cpx (24.1%), CRF 20, 23, 24_BG (23.4%) and CRF18_cpx (12%). Overall, the prevalence of PDR was 29.8% (95%, CI 22.3-38.1). The prevalence was 12.8% (95%, CI 6.07-16.9) for any nucleoside reverse transcriptase inhibitor (NRTI), 23.4% (95%, CI 16.7-31.3) for any non-reverse transcriptase inhibitor (NNRTI) and 1.4% (95%, CI 0.17-5.03) for any protease inhibitor (PI). The most frequent mutations detected were K103N (12.9%), G190A (6.4%) and Y181C (4.8%).
The NNRTI prevalence above 10% in our study indicates that the first-line antiretroviral therapy in Cuba may be less effective and supports the need to look for new treatment options that contribute to therapeutic success and help the country achieve the global goals 90-90-90 set forth by UNAIDS.