Emergence of HIV drug-resistant mutations in East Indian population after failure of first-line antiretroviral therapy

Introduction: There are limited data on the failure of first-line antiretroviral therapy (ART) in resource- limited settings. In particular, there have not been any re-ports on first-line ART failure among patients in eastern India. We review data on the emergence of human immunodeficiency virus (HIV) drug resistance among indi-viduals with reported first-line ART failure.

Material and methods: Results of genotypic drug resistance testing were obtained from plasma samples of 44 patients who had presented with clinical or im-munological failure to treatment after at least six months of ART. Major drug re-sistance mutations (DRMs) associated with any of the three classes of anti­retroviral (ARV) drugs, nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside re-verse trans­criptase inhibitors (NNRTI), and protease inhibitors (PI) were seen in all pa-tients (100% prevalence).

Results: NRTI and NNRTI DRMs were encountered at a frequency of 34 (77.27%) and 15 (34.09%) amongst 44 patients, with M184V (34.09%), T215F (25.0%), and K219E (20.45%) being the most frequent among NRTI associated mutations, and Y188L (18.18%), K103N (6.81%), and A98G (6.81%) among NNRTI associated ones. PI DRMs were observed in 5/44 (11.3%) patients, with V82L, V82S, and I84V being the commonest.

Conclusions: These results present a high prevalence of DRMs among ART patients from eastern India with clinical or immunological failure. It is very important to enhance the access of ARV drugs so that their compliance could be improved and hence development of DRMs be minimised.