Antiretroviral Drug Resistance in a Respondent-Driven Sample of HIV-Infected Men Who Have Sex With Men in Brazil

Authors:Bermúdez-Aza, Elkin Hernan MD, MSc; Kerr, Ligia Regina Franco Sansigolo MD, PhD; Kendall, Carl PhD; Pinho, Adriana Araujo MSc; de Mello, Maeve Brito PhD; Mota, Rosa Salani MSc; Guimarães, Mark Drew Crosland PhD; Alencar, Cecilia Salete MSc; de Brito, Ana Maria PhD; Dourado, Ines Costa PhD; da Batista, Sonia Maria Batista MSc; Abreu, Fabiano BSc; de Oliveira, Lisangela Cristina MSc; de Souza Moraes, Adão MSc; Benzaken, Adele Schwartz MD, PhD; Merchan-Hamann, Edgar MD, PhD; de Freitas, Gisele Maria Brandão MD, MSc; McFarland, Willi MD, PhD; Albuquerque, Elizabeth PhD; Rutherford, George W MD, MSc; Sabino, Ester MD, PhD

Background: There are few studies on HIV subtypes and primary and secondary antiretroviral drug resistance (ADR) in community-recruited samples in Brazil. We analyzed HIV clade diversity and prevalence of mutations associated with ADR in men who have sex with men in all five regions of Brazil.

Methods: Using respondent-driven sampling, we recruited 3515 men who have sex with men in nine cities: 299 (9.5%) were HIV-positive; 143 subjects had adequate genotyping and epidemiologic data. Forty-four (30.8%) subjects were antiretroviral therapy-experienced (AE) and 99 (69.2%) antiretroviral therapy-naïve (AN). We sequenced the reverse transcriptase and protease regions of the virus and analyzed them for drug resistant mutations using World Health Organization guidelines.

Results: The most common subtypes were B (81.8%), C (7.7%), and recombinant forms (6.9%). The overall prevalence of primary ADR resistance was 21.4% (i.e. among the AN) and secondary ADR was 35.8% (i.e. among the AE). The prevalence of resistance to protease inhibitors was 3.9% (AN) and 4.4% (AE); to nucleoside reverse transcriptase inhibitors 15.0% (AN) and 31.0% (AE) and to nonnucleoside reverse transcriptase inhibitors 5.5% (AN) and 13.2% (AE). The most common resistance mutation for nucleoside reverse transcriptase inhibitors was 184V (17 cases) and for nonnucleoside reverse transcriptase inhibitors 103N (16 cases).

Conclusions: Our data suggest a high level of both primary and secondary ADR in men who have sex with men in Brazil. Additional studies are needed to identify the correlates and causes of antiretroviral therapy resistance to limit the development of resistance among those in care and the transmission of resistant strains in the wider epidemic.