XVIII International AIDS Conference


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Brazilian network for HIV-1 genotyping (RENAGENO): prevalence of drug resistance mutations and HIV-1 subtypes among patients under antiretroviral therapy in Rio de Janeiro, Brazil

L.A. Inocêncio1, A. Azevedo2, C. Silva-de-Jesus3, M.C. Rachid4, D.F. Souza2, V. Veloso5, M. Simão2, J. Couto-Fernandez3

1Ministry of Health - Brazil, DST/AIDS, Brasília, Brazil, 2Brazilian Ministry of Health, Brasília, Brazil, 3Oswaldo Cruz Foundation-FIOCRUZ, Rio de Janeiro, Brazil, 4Secretaria Estadual da Saúde do Rio de Janeiro, Rio de Janeiro, Brazil, 5Evandro Chagas Clinical Research Institute (FIOCRUZ/RJ), Rio de Janeiro, Brazil

Background: Since 1992, the Brazilian Ministry of Health established the free universal access to antiretroviral therapy (ART) through the Public Health System. Nowadays, around 200.000 HIV-1 infected patients are under treatment. As a support to new ART strategies for failing patients, the HIV-1 resistance genotyping test has been applied through the National Network for HIV-1 Genotyping (RENAGENO). In this study, we assessed the distribution of HIV-1 subtypes and drug resistance mutations in the Rio de Janeiro State, Brazil.
Methods: Between 2002 and 2010, a total of 3,829 blood samples from patients failing ART were received for HIV-1 genotyping from the whole Rio de Janeiro state. In these, a total of 3,299 patients were genotyped for evaluation of HIV-1 drug resistance.
Results: The majority of the genotyped samples were classified as subtype B (85%), followed by subtype F (7%), BF recombinant forms (5%) and subtype C (1.5%). HIV-1 subtype D and the CRF02_AG were identified in 5 patients (0.15% each). In addition, to subtype G, subtype A1 and unique recombinant forms BC, CF and AF in two patients each. The drug resistance profile for the nucleoside reverse transcriptase inhibitors (NRTI) showed the M184V mutation as the most prevalent (69%). A total of 45% of the patients showed some resistance mutations to the NRTIs, 78% to non-nucleoside RTIs (NNRTIs) and 23% to the protease inhibitors (PIs).
Conclusions: Our results show a significant proportion of drug resistance among patients failing ART, mainly to RTIs. However, a low prevalence of resistance mutations to the new generation of PIs and to NNRTI were observed in our large database of the HIV-1 genotyping test. The maintenance of HIV-1 genotyping programs has substantially contributed for the management of ART in failure patients, both for first line and rescue therapy.
Support: Brazilian Ministry of Health (DDAHV/ULAB) and FIOCRUZ.

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