P22.02
Background: Current suppressive combination antiretroviral therapy (cART) has improved the health and life spam in HIV-1 infected patients. However, the long-term efficacy of cART has been compromised in many individuals, often due to the development of drug-resistance mutations (DRM). Surveillance of DRM in antiretroviral-experienced patients may provide useful information regarding rescue intervention.
Methods: Plasma sample from HIV-1 infected patients on cART with signs of virological, and/or immunological and/or clinical failure were collected during April 2013 to March 2014, at the two principal HIV-care clinics in Tegucigalpa, Honduras. DRM analysis of HIV-1 pol sequences were obtain with the Stanford University Database.
Results: A total of 165 specimens were analyzed. The proportion of patients with DRM was 75% (95% IC: 68-81%), 74% in adults and 92% in children. DRM were 85% for NRTI, 92% for NNRTI and 11% for PI. Overall, 21.1% patients showed DRM to at least one drug class (6.5% for NRTI and 14.6% for NNRTI), 69.9% to at least two (67.5% for NRTI+NNRTI, 0.8% for NRTI+PI, and 1.6% for NNRTI+PI), and 9% to all three drug families (NRTI+NNRTI+PI). DRM was observed in 64% patients who were on first cART regimen, 26% on second, 9% on third, and one patient (0.8%) was on his seventh cART regimen.
Conclusions: This is the second study of this kind, since cART has been implemented in the country in 2002. The rate of DRM has slightly declined (75%) in antiretroviral-experience patients with treatment failure compare with the rate reported in 2009 (81%). The majority of the patients showed single- and dual-class resistance. There has been a significant decreasing of multi-drug resistance from 33% reported in 2009 to 9% in 2014 (p<0.0001). Resistance testing implementation is an urgent need in the country because the management of heavily treatment-experience HIV-infected patients represents a considerable challenge for HIV-care clinicians.
