Prevalence of HIV drug resistance in treatment experienced, chronically HIV-infected individuals from Panama
G. Arteaga1,2, J. Castillo1, A. Martínez1, Y. Mendoza1,2, J. Meléndez3, D. Mojica4, R. Samaniego5, K.R. Page6, J.M. Pascale1,2, Gorgas Panama
1Gorgas Memorial Institute for Health Studies, Panama, Panama, 2University of Panama/ Medicine Faculty, Panama, Panama, 3Hospital Rosales, Guatemala, Guatemala, 4Laboratorio Regional de Referencia de VIH/SIDA-Centroamérica, Panama, Panama, 5Hospital Santo Tomás, Panama, Panama, 6John Hopkins University- School of Medicine, Baltimore, United States
Background: Acquired HIV drug resistance reduces the efficacy of antiretroviral therapy (ARV), and has become a public health concern. The aim of the study was to describe the prevalence of HIV drug resistance in Panama.
Methods: From February 2007 to January 2010, 145 samples from subjects with suspected ARV treatment failure were evaluated using HVI genotyping.
Results: Clinically significant mutations to one or more of the three ARV treatment groups were observed in 73% of the samples (106/145).
[% Of Mutations Associated to Therapeutic Failure]
Highest percentage of mutations was observed in the NRTI´s group, followed by NNRTI´s and PI´s groups (Table 1). More than 84% of the patients with confirmed treatment failure showed resistance to one of the drugs used as in first line regimen in Panama (efavirenz, 3TC or AZT), and 10% of the samples showed mutations that confer resistance to the three ARV groups. Even though etravirine is not used in the country, mutations associated with etravirine resistance were observed in 17% of the cases.
[Porcentage of Mutations by ARV Group]
| ||NRTI´s (84.9%,Alone or combined)||NNRTI´s (78.2%,Alone or combined)||PI´s (18.8%,Alone or combined)|
|Mutation by ARV Group||M184V||TAM´s||L74V||K103N||Other not K103N||*Etravirine||*LPVr/
Conclusions: The high prevalence of acquired resistance to NRTI´s is concerning since it may impact the clinical response to subsequent regimens. The accumulation of TAM´s and NNRTI´s mutations which confer resistance to etravirine suggests that patients are maintained on failing 1st line regimens for prolonged periods of time. More frequent viral load monitoring and stronger adherence programs should be implemented in Panama.
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