Caracterização da resistência transmitida e variabilidade genética do HIV-1 em pacientes recém-diagnosticados atendidos no centro de testagem e aconselhamento (CTA) em Fortaleza

Abstract

Antiretroviral therapy aims to reduce morbidity and mortality of people with HIV / AIDS, improving the quality and life expectancy. Paradoxically, the irregular treatment may favor the selection of resistant variants, representing a major cause of treatment failure. Such resistant strains can be transmitted to other individuals (transmitted resistance) predisposing to early failure of the inaugural treatment. Resistance tests, particularly genotyping, allow mutation detection in the viral genome. The aim of this study was to characterize the transmitted resistance HIV-1 mutations to antiretroviral drugs in newly diagnosed patients in the Counseling and Testing Center (CTC) in Fortaleza. During the period October 2013 to September 2014, patients with reagent test for HIV were recruited at CTC. Samples for viral load quantitation (Abbott RealTime), CD4 lymphocytes count (BD FACSCalibur) and HIV-1 genotyping (TRUGENE Siemens), were collected. Genetic sequences were aligned by MEGA and BioEdit program. The subtypes of HIV-1 were determined and identified using analysis in REGA HIV subtyping Tool database. The analysis of the antiretroviral resistance mutation was performed using the algorithm of Stanford University (HIVdb Program) and transmitted mutation resistance was identified using the Calibrated Population Resistance (CPR). Biological samples were obtained from 108 patients, among which in 105 was possible to perform the sequencing reaction and evaluation for the presence of mutations to confer antiretroviral drug resistance. The overall prevalence of transmitted resistance in this study was 9.5% (N=10), of those, 2.9% to the NRTI, 5.7% to NNRTI and 1.9% to protease inhibitors. The most prevalent mutation was K103N (25%). The identification of subtypes was performed on 105 samples, being most prevalent subtype B (86.7%), followed by F1 (3.8%) and C (2.8%), as well as recombinant forms (5.7%). It was detected for the first time in Ceará the CRF02_AG (1.9%). BF recombinants were found in 3.8%, F subtype in protease and subtype B in reverse transcriptase, one of those was classified as CRF12_BF. The surveillance of the prevalence of transmitted resistance mutations and the genetic diversity description of the epidemic in the region's population are fundamental to the definition of public health policies.