Prevalence of HIV Drug Resistance Mutation in the Northern Indian Population After Failure of the First Line Antiretroviral Therapy
S. Sinha, R. C. Shekhar, H. Ahmad, N. Kumar, J. C. Samantaray, V. Sreenivas, N. H. Khan and R. T. Mitsuyasu
Affiliation: Department of Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India.
Keywords: ARV, DRMs, HIV-1, resistance, reverse transcriptase, protease, AIDS, HAART, NACO, CD4 cell counts.
There is limited information available about the prevalence and pattern of human immunodeficiency virus
(HIV) drug resistance mutations (DRMs) among antiretroviral therapy (ART) experienced patients from northern India.
Results of genotypic drug resistance testing were obtained from plasma samples of 128 patients, who had presented with
clinical or immunological failure to treatment after at least six months of ART. Major DRMs associated with any of the
three classes of antiretroviral (ARV) drugs, nucleoside reverse transcriptase inhibitors (NRTI), non-nucleoside reverse
transcriptase inhibitors (NNRTI) and protease inhibitors (PI), were seen in 120 out of 128 patients (93.8% prevalence).
NRTI and NNRTI DRMs were each seen in 115/128 (89.8%) patients, with M184V, M41L, D67N and T215Y being the
most frequent among NRTI associated mutations, and K103N, G190A, Y181C and A98G among NNRTI associated ones.
PI DRMs were observed in 14/128 (10.9%) patients, with L10I, V82A and L89V being the commonest. These results
present a high prevalence of DRMs among ARTexperienced patients from northern India with clinical or immunological
failure of therapy. It emphasizes the need for regular testing of plasma samples of such patients for DRMs in order to
detect and replace a failing regimen early, and also the use of HIV drug resistance genotyping of ART naive individuals
prior to initiating first line ART for possible transmitted resistance. It is very important to enhance the access of patients to
ARV drugs so that their compliance could be improved and hence development of DRMs be minimized.
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