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Made available in DSpace on 2018-11-26T20:08:58Z (GMT). No. of bitstreams: 0 Previous issue date: 2018-03-01
Brazilian Ministry of Health
Introduction: In Brazil, more than 487,450 individuals are currently undergoing antiretroviral treatment. In order to monitor the transmission of drug-resistant strains and HIV subtype distribution in the country, this work aimed to estimate its prevalence and to characterize the nationwide pretreatment drug resistance in individuals recently diagnosed with HIV between 2013 and 2015. Methods: The HIV threshold survey methodology (HIV-THS, WHO) targeting antiretroviral-naive individuals with recent HIV diagnosis was utilized, and subjects were selected from 51 highly populated cities in all five Brazilian macroregions. The HIV pol genotypic test was performed by genomic sequencing. Results: We analysed samples from 1568 antiretroviral-naive individuals recently diagnosed with HIV, and the overall transmitted drug resistance (TDR) prevalence was 9.5% (150 sequences). The regional prevalence of resistance according to Brazilian geographical regions was 9.4% in the northeast, 11.2% in the southeast, 6.8% in the central region, 10.2% in the north and 8.8% in the south. The inhibitor-specific TDR prevalence was 3.6% for nucleoside reverse transcriptase inhibitors (NRTIs), 5.8% for non-nucleoside reverse transcriptase inhibitors (NNRTIs) and 1.6% for protease inhibitors (PIs); 1.0% of individuals presented resistance to more than one class of inhibitors. Overall, subtype B was more prevalent in every region except for the southern, where subtype C prevails. Conclusions: To the best of our knowledge, this is the first TDR study conducted in Brazil with nationwide representative sampling. The TDR prevalence revealed a moderate rate in the five Brazilian geographical regions, although some cities presented higher TDR prevalence rates, reaching 14% in Sao Paulo, for example. These results further illustrate the importance of surveillance studies for designing future strategies in primary antiretroviral therapy, aiming to mitigate TDR, as well as for predicting future trends in other regions of the globe where mass antiretroviral (ARV) treatment was implemented.
Univ Fed Rio de Janeiro, Lab Virol Mol, Dept Genet IB, Rio De Janeiro, RJ, Brazil
Fdn Med Trop Amazonas, Manaus, Amazonas, Brazil
LAPI Univ Fed Bahia, Hosp Univ Prof Edgar Santos, Lab Pesquisa, Salvador, BA, Brazil
Lab Cent Saude Publ Ceara Lacen CE, Fortaleza, Ceara, Brazil
Lab Cent Saude Publ Dist Fed, Setor Grandes Areas Norte SGAN 601, Brasilia, DF, Brazil
Univ Fed Minas Gerais UFMG, Fac Med, Lab Imunol & Biol Mol DIP, Belo Horizonte, MG, Brazil
Lab Cent Saude Publ Mato Grosso Sul, Campo Grande, MS, Brazil
Lab Cent Saude Publ Pernambuco, Recife, PE, Brazil
Lab Municipal Curitiba, Curitiba, PR, Brazil
Fiocruz MS, Lab AIDS & Imunol Mol, Dept Imunol, Rio De Janeiro, RJ, Brazil
Univ Fed Rio de Janeiro, Hosp Univ Clementino Fraga Filho, Lab Carga Viral, Rio de Janeiro, RJ, Brazil
Inst Biol Exercito, Rio De Janeiro, RJ, Brazil
Lab Cent Saude Publ Rio Grande Sul, Porto Alegre, RS, Brazil
Lab Hosp Nossa Senhora Conceicao, Porto Alegre, RS, Brazil
Lab Cent Saude Publ Santa Catarina, Florianopolis, SC, Brazil
UNESP, Lab Biol Mol Hemocentro Botucatu, Fac Med, Botucatu, SP, Brazil
Univ Estadual Campinas, Lab Pesquisa AIDS, Hosp Clin, Campinas, SP, Brazil
Inst Adolfo Lutz Sao Jose do Rio Preto, Lab Biol Mol, Sao Jose Do Rio Preto, SP, Brazil
Univ Fed Sao Paulo UNIFESP, Escola Paulista Med, Lab Retrovirol, Sao Paulo, SP, Brazil
Inst Adolfo Lutz Cent, Lab Retrovirus, Ctr Virol, Nucleo Doencas Sanguineas & Sexuais, Sao Paulo, SP, Brazil
Minist Saude, Dept Vigilancia Prevencao & Controle DST AIDS & H, Setor Adm Fed Sul SAFS 02, Secretaria Vigilancia Saude, Brasilia, DF, Brazil
Univ Brasilia, Programa Pos Grad Saude Colet, Fac Med, Fac Ciencias Saude, Brasilia, DF, Brazil
Univ Sao Paulo, Fac Med, Sao Paulo, SP, Brazil
UNESP, Lab Biol Mol Hemocentro Botucatu, Fac Med, Botucatu, SP, Brazil
Brazilian Ministry of Health: TC 298/12
