Transmitted Drug Resistance in Newly Diagnosed, Treatment-Naıve, HIV Type 1-Infected Patients in Hungary

Áy, Éva and Müller, Viktor and Mezei, Mária and Pocskay, Ágnes and Koroknai, Anita and Müller, Dalma and Győri, Zoltán and Marschalkó, Márta and Tóth, Béla and Kárpáti, Sarolta and Lakatos, Botond and Szlávik, János and Takács, Mária and Minárovits, János (2019) Transmitted Drug Resistance in Newly Diagnosed, Treatment-Naıve, HIV Type 1-Infected Patients in Hungary. Journal of Global Antimicrobial Resistance. (In Press)

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Abstract

Objectives Transmitted HIV-1 drug resistance (TDR) may affect the success of first-line antiretroviral treatment. The aim of this study was to monitor the presence of HIV-1 strains carrying transmitted drug resistance-associated mutations (TDRMs) in newly diagnosed, treatment-naïve patients in Hungary. Methods 168 HIV-infected individuals diagnosed between 2013 and 2017 were included in the study; most of them (93.5%) belonged to the homo/bisexual population. HIV-1 subtypes and TDRMs were determined by analysing the protease and reverse transcriptase coding regions of the pol gene by the Stanford HIV Drug Resistance Database. Transmission clusters among patients were identified using phylogenetic analysis. Results Although subtype B HIV-1 strains were predominant (87.5%), non-B subtypes including F, A, CRF01_AE, CRF02_AG, D and G were also recorded, especially in young adults. The overall prevalence of TDR was 10.7% (18/168; 95% CI: 6.9-16.3%). Subtype B HIV-1 strains carried most of the TDRMs (94.4%). Nucleoside reverse transcriptase inhibitor (NRTI)-associated mutations were the most prevalent indicators of TDR (16/168; 9.5%; 95% CI: 5.9-14.9%), followed by mutations conferring resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs) (2/168; 1.2%; 95% CI: 0.3-4.2%) and protease inhibitors (PIs) (1/168, 0.6%; 95% CI: 0.1-3.3%). Phylogenetic analysis revealed that most NRTI-associated resistance mutations were associated with a single monophyletic clade, suggesting early single source introduction and ongoing spread of this drug resistant HIV-1 strain. Conclusions Onward transmission of drug resistant subtype B HIV-1 strains accounted for the majority of TDRs observed among treatment-naïve HIV-infected individuals in Hungary.

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