Download POSTER IDWEEK 2015 DEFINITIVO

Transmitted Drug Resistance and HIV Molecular Epidemiology in Nicaragua
Guillermo Porras-Cortés, MD2*; Santiago Avila-Ríos, PhD1; Claudia García-Morales, MSc1; Daniela Tapia-Trejo1;
Sumaya Moreira-López, MD2; Bismarck Hernández-Álvarez3; Carlos Quant-Durán, MD2,3*; Gustavo Reyes-Terán, MD1*
1Centre
2Hospital
BACKGROUND: HIV Transmitted Drug
Resistance (TDR) prevalence and
trends, as well as HIV molecular
epidemiology in Nicaragua are
unknown. Knowledge on HIV TDR is
important both for therapeutic
decision-making and to establish
public health policies on antiretroviral
treatment (ART). We present results
oF the first study to determine HIV
TDR and molecular epidemiology in
Nicaragua
OBJECTIVE:
To determine the
prevalence and patterns of TDR as well
as some characteristics of HIV molecular
epidemiology in a cohort of ART naïve
Nicaraguan individuals.
METHODS: HIV-infected, ART-naïve
Nicaraguan individuals were enrolled
from 2011 to 2015. Blood samples
were collected at Hospital Roberto
Calderón in Managua and sent to the
Centre for Research in Infectious
Diseases in Mexico City, a WHO
accredited
laboratory,
to
be
processed. HIV pol sequences were
obtained by the Sanger method,
using an in-house developed assay,
and assembled using the software
RECall
(University
of
British
Columbia, Canada). HIV subtyping
was performed with REGA Subtyping
Tool v2 and RIP 3.0, available on line.
TDR was assessed using the WHO
TDR surveillance mutation list.
for Research in Infectious Diseases, National Institute of Respiratory Diseases, Mexico City, Mexico.
Metropolitano Vivian Pellas, Managua, Nicaragua. 3Hospital Roberto Calderón, Managua, Nicaragua.
RESULTS (1): A total of 260 individuals were enrolled in the study. The median age was 32 years (IQR 26-40). The median viral load was 4.8 log RNA copies/mL (IQR 4.2-5.4) and the median CD4+ T cell count was 310
cells/mm3 (IQR 111-462). During the study period the overall TDR prevalence was 15.0% (95%CI: 10.9-19.9%). A higher TDR prevalence was found for NRTI (8.5%, 95%CI: 5.4-12.5%) and NNRTI (6.9%, 95%CI: 4.210.7%) compared to PI (1.9%, 95%CI: 0.6-4.4%, p<0.05) (Figure 1).
Table 1: Prevalence and trends of TDR.
p<0.05
Figure 2: TDR mutations for NRTI
Figure 1: Overall and specific TDR
Figure 3: TDR mutations for NNRTI
RESULTS (2): Individuals using IV drugs were more prone to present TDR (OR 11.8, 95%CI: 1.9-73.8, p=0.01) and individuals with TDR had higher CD4+ T cell counts than individuals without TDR (p=0.04). No other
demographic or clinical variables were associated with TDR. A significant increase in NNRTI TDR was observed for the 2013-2015 period (9.7%, 95%CI: 5.4-15.8) compared to the 2011-2012 period (3.4%, 95%CI:
0.9-8.6) (Table 1). The most frequent TDR mutations were M41L for NRTI, K103N for NNRTI, and M46IL for PI (Figures 2, 3, 4). A large cluster of viruses with NRTI TDR from men who have sex with men was
observed (Figure 5). Subtype B was the most prevalent (98.3%) and non-B subtypes included BD (1.3%) and BF1 (0.4%) viruses (Figure 6).
98.3%
1.3%
0.4%
B
Figure 4: TDR mutations for PI
Figure 5: Clusters of viruses with TDR
Non-B
BD
Figure 6: HIV subtypes
BF1
CONCLUSION: The overall TDR in the study cohort
was borderline high, according to WHO
classification, with higher TDR to NRTI. An
increasing trend in time of NNRTI TDR was
observed. Transmission of NNRTI TDR occurred
frequently ampong MSM. Sutype B was the most
common.
Corresponding authors:
Dr. Gustavo Reyes-Terán, Centre for Research in Infectious
Diseases, National Institute of Respiratory Diseases, Mexico City,
Mexico
[email protected]
Dr. Carlos Quant-Durán, Hospital Roberto Caldrón, Managua,
Nicaragua
[email protected]
Dr. Guillermo Porras-Cortés, Hospital Metropolitano Vivian Pellas,
Managua, Nicaragua
[email protected]