High prevalence of human immunodeficiency virus type 1 drug resistance mutations in antiretroviral treatment-experienced patients from Pune, India.

We report one or more HIV resistance mutations in 81.81% of the 33 antiretroviral treatment-experienced study participants with evidence of virologic failure, with M184V being the most commonly observed resistance mutation (69.7%). Two out of four participants with protease inhibitors (PI) experience harbored multiple PI-associated resistance mutations. No resistance mutations were observed in 22 treatment-naive study plasma sequences. All the study pol sequences were subtype C, except one that was subtype A1. On analyzing paired plasma-proviral DNA sequences from 16 treatment-experienced patients, which harbored mutations at positions associated with antiretroviral drug resistance, an 87.5% discordance in reverse transcriptase mutations was seen between the two compartments. Our study highlights the high prevalence of HIV resistance mutations in treatment-experienced patients in Pune, with protease major resistance mutations being reported for the first time from India. The proviral DNA resistance mutation patterns may have an impact on the clinical management of HIV/AIDS.