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Prevalence of HIV-1 transmitted drug resistance and its impact on the effectiveness of antiretroviral therapy - Minas Gerais state, Brazil / Prevalência de resistência transmitida do HIV-1 e seu impacto na efetividade da terapia antirretroviral – Minas Gerais, Brasil

The transmission and occurrence of resistance associated mutations (RAMs) are among the challenges for a successful HIV Treatment. Therefore, continuous HIV drug resistance surveillance of prevalence and incidence is recommended. The objective this study was to analyze the prevalence and impact of transmitted drug resistance (TDR) on the first-line ART effectiveness. This is a retrospective observational study that evaluated HIV-1-infected treatment-naïve individuals with pre-antiretroviral therapy (ART) genotype resistance test results, between 2014 and 2015, in Minas Gerais state’s, Brazil. The ART effectiveness was compared in individual with and without TDR, considering viral load (VL) 50 copies/mL at the 12 and 24-month endpoint. Reverse transcriptase and protease sequences were genotyped by Sanger sequencing. A total of 170 individuals were selected. HIV-1 subtype B was highly prevalent (63.5%) and prevalence of TDR was 14.1%. That included 62.5% RAMs associated with non-nucleoside reverse-transcriptase inhibitors (NNRTIs), 29.2% with nucleos(t)ide transcriptase inhibitors (NRTIs) and 25% with protease inhibitors (PIs). The overall ART effectiveness measured at 12 and 24 months was, respectively: 91.0% and 93.4% between individuals without TDR; 88.2% and 93.3% in individuals with TDR. Among the individuals starting first-line ART with less than three active drugs (16/24), seven individuals achieved VL 50 copies/mL in the presence of K103N mutation and receiving efavirenz-containing ART. Moderate prevalence of TDR was observed in this study, although observed that some NNRTI TDR, did not impact on the effectiveness of efavirenz-based regimens, without major differences on the effectiveness of first-line ART between the groups with or without TDR.