National prevalence and trends of HIV transmitted drug resistance in Mexico

• Published in: PloS one 2011-11, Vol.6 (11), p.e27812-e27812
• Main Authors: Avila-Ríos, Santiago, García-Morales, Claudia, Garrido-Rodríguez, Daniela, Ormsby, Christopher E, Hernández-Juan, Ramón, Andrade-Villanueva, Jaime, González-Hernández, Luz A, Torres-Escobar, Indiana, Navarro-Álvarez, Samuel, Reyes-Terán, Gustavo
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - pharmacology; Antiretroviral agents; Antiretroviral drugs; Automation; Bioinformatics; Biology; Clustering; Cohort Studies; DNA-Directed RNA Polymerases - blood; Donations; Drug resistance; Drug Resistance, Viral - genetics; Drug therapy; Epidemics - statistics & numerical data; Epidemiology; Female; Genetic Variation; Health aspects; Highly active antiretroviral therapy; HIV; HIV infections; HIV Infections - blood; HIV Infections - transmission; HIV-1 - classification; HIV-1 - drug effects; HIV-1 - enzymology; HIV-1 - genetics; Hospitals; Human immunodeficiency virus; Humans; Infection; Infections; Laboratories; Male; Medical diagnosis; Medical research; Medicine; Mexico - epidemiology; Mutation; Phylogenetics; Phylogeny; Prevalence; Respiratory diseases; Surveillance; Trends; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0027812

Transmitted drug resistance (TDR) remains an important concern for the management of HIV infection, especially in countries that have recently scaled-up antiretroviral treatment (ART) access. We designed a study to assess HIV diversity and transmitted drug resistance (TDR) prevalence and trends in Mexico. 1655 ART-naïve patients from 12 Mexican states were enrolled from 2005 to 2010. TDR was assessed from plasma HIV pol sequences using Stanford scores and the WHO TDR surveillance mutation list. TDR prevalence fluctuations over back-projected dates of infection were tested. HIV subtype B was highly prevalent in Mexico (99.9%). TDR prevalence (Stanford score>15) in the country for the study period was 7.4% (95% CI, 6.2∶8.8) and 6.8% (95% CI, 5.7∶8.2) based on the WHO TDR surveillance mutation list. NRTI TDR was the highest (4.2%), followed by NNRTI (2.5%) and PI (1.7%) TDR. Increasing trends for NNRTI (p = 0.0456) and PI (p = 0.0061) major TDR mutations were observed at the national level. Clustering of viruses containing minor TDR mutations was observed with some apparent transmission pairs and geographical effects. TDR prevalence in Mexico remains at the intermediate level and is slightly lower than that observed in industrialized countries. Whether regional variations in TDR trends are associated with differences in antiretroviral drug usage/ART efficacy or with local features of viral evolution remains to be further addressed.