D Paraskevis1, E Kostaki2, G Magiorkinis2, P Gargalianos3, G Xylomenos3, E Magiorkinis2, M Lazanas4, M Chini4, G Nikolopoulos5, A Skoutelis6, V Papastamopoulos6, A Antoniadou7, A Papadopoulos7, M Psichogiou8, G L Daikos8, M Oikonomopoulou2, A Zavitsanou2, G Chrysos9, V Paparizos10, S Kourkounti10, H Sambatakou11, N V Sipsas12, M Lada13, P Panagopoulos14, E Maltezos14, S Drimis9, A Hatzakis2. 1. Department of Hygiene,, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece. Electronic address: dparask@med.uoa.gr. 2. Department of Hygiene,, Epidemiology and Medical Statistics, National and Kapodistrian University of Athens, Athens, Greece. 3. 1st Department of Internal Medicine, G. Genimatas GH, Athens, Greece. 4. 3rd Internal Medicine Department-Infectious Diseases, Red Cross Hospital, Athens, Greece. 5. Medical School, University of Cyprus. 6. 5th Department of Medicine and Infectious Diseases, Evaggelismos GH, Athens, Greece. 7. 4th Department of Medicine, Attikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 8. 1st Department of Medicine, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 9. Department of Internal Medicine, Tzaneio GH, Piraeus, Greece. 10. HIV/AIDS Unit, A. Syngros Hospital of Dermatology and Venereology, Athens, Greece. 11. HIV Unit, 2nd Department of Internal Medicine, Hippokration GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 12. 1st Department of Pathophysiology, Laikon GH, Medical School, National and Kapodistrian University of Athens, Athens, Greece. 13. 2nd Department of Internal Medicine, Sismanogleion GH, Athens, Greece. 14. Department of Internal Medicine, University GH, Democritus University of Thrace, Alexandroupolis, Greece.
Abstract
BACKGROUND: The prevalence of HIV-1 drug resistance among treatment-naïve patients ranges between 8.3% and 15% in Europe and North America. Previous studies showed that subtypes A and B were the most prevalent in the Greek HIV-1 epidemic. Our aim was to estimate the prevalence of resistance among drug naïve patients in Greece and to investigate the levels of transmission networking among those carrying resistant strains. METHODS: HIV-1 sequences were determined from 3428 drug naïve HIV-1 patients, in Greece sampled during 01/01/2003-30/6/2015. Transmission clusters were estimated by means of phylogenetic analysis including as references sequences from patients failing antiretroviral treatment in Greece and sequences sampled globally. RESULTS: The proportion of sequences with SDRMs was 5.98% (n=205). The most prevalent SDRMs were found for NNRTIs (3.76%), followed by N(t)RTIs (2.28%) and PIs (1.02%). The resistance prevalence was 22.2% based on all mutations associated with resistance estimated using the HIVdb resistance interpretation algorithm. Resistance to NNRTIs was the most common (16.9%) followed by PIs (4.9%) and N(t)RTIs (2.8%). The most frequently observed NNRTI resistant mutations were E138A (7.7%), E138Q (4.0%), K103N (2.3%) and V179D (1.3%). The majority of subtype A sequences (89.7%; 245 out of 273) with the dominant NNRTI resistance mutations (E138A, K103N, E138Q, V179D) were found to belong to monophyletic clusters suggesting regional dispersal. For subtype B, 68.1% (139 out of 204) of resistant strains (E138A, K103N, E138Q V179D) belonged to clusters. For N(t)RTI-resistance, evidence for regional dispersal was found for 27.3% and 21.6% of subtype A and B sequences, respectively. CONCLUSIONS: The TDR rate based on the prevalence of SDRM is lower than the average rate in Europe. However, the prevalence of NNRTI resistance estimated using the HIVdb approach, is high in Greece and it is mostly due to onward transmissions among drug-naïve patients.
BACKGROUND: The prevalence of HIV-1 drug resistance among treatment-naïve patients ranges between 8.3% and 15% in Europe and North America. Previous studies showed that subtypes A and B were the most prevalent in the Greek HIV-1 epidemic. Our aim was to estimate the prevalence of resistance among drug naïve patients in Greece and to investigate the levels of transmission networking among those carrying resistant strains. METHODS:HIV-1 sequences were determined from 3428 drug naïve HIV-1patients, in Greece sampled during 01/01/2003-30/6/2015. Transmission clusters were estimated by means of phylogenetic analysis including as references sequences from patients failing antiretroviral treatment in Greece and sequences sampled globally. RESULTS: The proportion of sequences with SDRMs was 5.98% (n=205). The most prevalent SDRMs were found for NNRTIs (3.76%), followed by N(t)RTIs (2.28%) and PIs (1.02%). The resistance prevalence was 22.2% based on all mutations associated with resistance estimated using the HIVdb resistance interpretation algorithm. Resistance to NNRTIs was the most common (16.9%) followed by PIs (4.9%) and N(t)RTIs (2.8%). The most frequently observed NNRTI resistant mutations were E138A (7.7%), E138Q (4.0%), K103N (2.3%) and V179D (1.3%). The majority of subtype A sequences (89.7%; 245 out of 273) with the dominant NNRTI resistance mutations (E138A, K103N, E138Q, V179D) were found to belong to monophyletic clusters suggesting regional dispersal. For subtype B, 68.1% (139 out of 204) of resistant strains (E138A, K103N, E138Q V179D) belonged to clusters. For N(t)RTI-resistance, evidence for regional dispersal was found for 27.3% and 21.6% of subtype A and B sequences, respectively. CONCLUSIONS: The TDR rate based on the prevalence of SDRM is lower than the average rate in Europe. However, the prevalence of NNRTI resistance estimated using the HIVdb approach, is high in Greece and it is mostly due to onward transmissions among drug-naïve patients.
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Authors: Maja M Lunar; Snježana Židovec Lepej; Janez Tomažič; Tomaž D Vovko; Blaž Pečavar; Gabriele Turel; Manja Maver; Mario Poljak Journal: PLoS One Date: 2018-04-26 Impact factor: 3.240