Understanding drug resistance patterns across different classes of antiretrovirals used in HIV-1-infected treatment-Naïve and experienced patients in Mumbai, India

by Selleckchem | Feb 28 2023

Background: The aim of this study is to find out the proportion of treatment-naïve (Tn) and treatment-experienced (Te) patients experiencing HIV drug resistance (DR) to different classes of antiretrovirals (ARVs) being used for HIV treatment and their in class DR correlation.

Methods: A cross-sectional study was done on 109 HIV patients enrolled at a private hospital in Thane, India, from 2014 to 2019. All patients were tested for CD4 count, viral load, and resistance to ARVs.

Results: Sixty-six patients were Tn and 43 patients were Te. Among Tn and Te patients, the percentage of high-level resistance (HLR) for nonnucleoside reverse transcriptase inhibitors (NNRTI) was 4.55% and 37.8%, respectively, for nucleoside reverse transcriptase inhibitors (NRTI) was 0.43% and 36.4%, respectively. No HLR was observed for protease inhibitors (PIs) among Tn patients, while Te patients showed 2.62% HLR. Tn and Te patients showed high susceptibility for Darunavir (98.48% and 95.34%, respectively) followed by Atazanavir and Lopinavir (96.96%, each and 90.69%, each). Tn patients showed HLR for Lamivudine and Emtricitabine (1.52%, each). Integrase Strand Transfer Inhibitors were susceptible (100%) in both Tn and Te patients. A positive correlation was observed for within class across ARVs.

Conclusion: An increased incidence of HLR was observed for NNRTI as compared to NRTI while PIs and integrase strand transfer inhibitors (INSTIs) demonstrated no HLR in either group of patients. When selecting a regimen for Tn patients consisting of NRTIs + NNRTIs genotypic DR test is essential. While with PIs or INSTIs its optional. Among Te patients, DR testing is recommended for all classes of drugs.

Comments：

This cross-sectional study conducted in Thane, India, found that treatment-experienced (Te) patients had a higher incidence of high-level resistance (HLR) to antiretroviral (ARV) drugs compared to treatment-naive (Tn) patients. For non-nucleoside reverse transcriptase inhibitors (NNRTIs), the HLR was 37.8% in Te patients and 4.55% in Tn patients. For nucleoside reverse transcriptase inhibitors (NRTIs), the HLR was 36.4% in Te patients and 0.43% in Tn patients. The HLR for protease inhibitors (PIs) was 2.62% in Te patients and 0% in Tn patients. The study also found that Darunavir, Atazanavir and Lopinavir showed high susceptibility in both Tn and Te patients, while Lamivudine and Emtricitabine showed HLR in Tn patients. Integrase Strand Transfer Inhibitors were found to be susceptible in both Tn and Te patients. The study observed a positive correlation for within class resistance across ARVs.In conclusion, the study highlights the importance of genotypic drug resistance testing before starting ARV treatment, especially for Te patients, and the selection of a regimen based on the results of the test. It is recommended to conduct a genotypic DR test when selecting a regimen consisting of NRTIs + NNRTIs for Tn patients, while it is optional when using PIs or Integrase Strand Transfer Inhibitors. For Te patients, DR testing is recommended for all classes of drugs.