Kotaki et al. AIDS Research and Therapy (2015) 12:5 DOI 10.1186/s12981-015-0046-y
RESEARCH
Open Access
HIV-1 transmitted drug resistance mutations among antiretroviral therapy-Naïve individuals in Surabaya, Indonesia Tomohiro Kotaki1,2, Siti Qamariyah Khairunisa1, Adiana Mutamsari Witaningrum1, Muhammad Qushai Yunifiar M1, Septhia Dwi Sukartiningrum1, Muhammad Noor Diansyah4, Retno Pudji Rahayu1, Nasronudin1,3 and Masanori Kameoka2,5*
Abstract Background: The emergence of transmitted drug resistance (TDR) compromises the effect of antiretroviral therapy (ART), resulting in treatment failure of human immunodeficiency virus (HIV) disease. Although more than a decade has passed since ART was introduced into Indonesia, information on TDR is limited. Here, a genotypic study of TDR among ART-naïve individuals was conducted in Surabaya, Indonesia. Method: HIV-1 seropositive participants were recruited from the communities of commercial sex workers and intravenous drug users as well as from the university teaching hospital in Surabaya. Protease (PR) and reverse transcriptase (RT) genes were sequenced in order to conduct HIV-1 subtyping and phylogenetic analysis and to detect TDR. TDR was defined as the presence of at least one surveillance drug resistance mutation on the WHO list or major drug resistance mutations in the International AIDS Society-USA panel. Result: Fifty two and 47 of the PR and RT genes, respectively, were successfully sequenced in the 58 samples. HIV-1 subtyping revealed that 86.3% (50/58) of the sequenced samples were classified as CRF01_AE, 8.6% as subtype B, 3.4% as B/CRF01_AE, and 1.7% as A/G/CRF01_AE. TDR of PR inhibitors was not detected in this study. In contrast, TDR of RT inhibitors was detected in 4.3% (2/47) of samples. In addition, minor drug resistance mutations were detected in 98.1% (51/52) and 12.8% (6/47) of PR and RT genes, respectively. Conclusion: This study clarified the predominance of the CRF01_AE strain in Surabaya, Indonesia. The prevalence of TDR was below 5%, indicating that the currently available first-line regimen is still effective in Surabaya. However, the prevalence might be underestimated since we detected only major population of HIV-1 in individuals. Therefore, continuous surveillance is required in order to detect the emergence of TDR in the early phase. Keywords: HIV-1, Antiretroviral therapy, Transmitted drug resistance, Indonesia
Backgrounds Antiretroviral therapy (ART) achieved the reduction of viral transmission, morbidity and mortality associated with human immunodeficiency virus (HIV) disease. However, the emergence of transmitted drug resistance (TDR) as a consequence of ART expansion represents a serious public health problem because TDR affects the treatment * Correspondence: [email protected] 2 Center for Infectious Diseases, Kobe University Graduate School of Medicine, Hyogo, Japan 5 Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan Full list of author information is available at the end of the article
efficacy and clinical outcome [1,2]. Although the prevalence of TDR in resource-limited countries is currently
RESEARCH
Open Access
HIV-1 transmitted drug resistance mutations among antiretroviral therapy-Naïve individuals in Surabaya, Indonesia Tomohiro Kotaki1,2, Siti Qamariyah Khairunisa1, Adiana Mutamsari Witaningrum1, Muhammad Qushai Yunifiar M1, Septhia Dwi Sukartiningrum1, Muhammad Noor Diansyah4, Retno Pudji Rahayu1, Nasronudin1,3 and Masanori Kameoka2,5*
Abstract Background: The emergence of transmitted drug resistance (TDR) compromises the effect of antiretroviral therapy (ART), resulting in treatment failure of human immunodeficiency virus (HIV) disease. Although more than a decade has passed since ART was introduced into Indonesia, information on TDR is limited. Here, a genotypic study of TDR among ART-naïve individuals was conducted in Surabaya, Indonesia. Method: HIV-1 seropositive participants were recruited from the communities of commercial sex workers and intravenous drug users as well as from the university teaching hospital in Surabaya. Protease (PR) and reverse transcriptase (RT) genes were sequenced in order to conduct HIV-1 subtyping and phylogenetic analysis and to detect TDR. TDR was defined as the presence of at least one surveillance drug resistance mutation on the WHO list or major drug resistance mutations in the International AIDS Society-USA panel. Result: Fifty two and 47 of the PR and RT genes, respectively, were successfully sequenced in the 58 samples. HIV-1 subtyping revealed that 86.3% (50/58) of the sequenced samples were classified as CRF01_AE, 8.6% as subtype B, 3.4% as B/CRF01_AE, and 1.7% as A/G/CRF01_AE. TDR of PR inhibitors was not detected in this study. In contrast, TDR of RT inhibitors was detected in 4.3% (2/47) of samples. In addition, minor drug resistance mutations were detected in 98.1% (51/52) and 12.8% (6/47) of PR and RT genes, respectively. Conclusion: This study clarified the predominance of the CRF01_AE strain in Surabaya, Indonesia. The prevalence of TDR was below 5%, indicating that the currently available first-line regimen is still effective in Surabaya. However, the prevalence might be underestimated since we detected only major population of HIV-1 in individuals. Therefore, continuous surveillance is required in order to detect the emergence of TDR in the early phase. Keywords: HIV-1, Antiretroviral therapy, Transmitted drug resistance, Indonesia
Backgrounds Antiretroviral therapy (ART) achieved the reduction of viral transmission, morbidity and mortality associated with human immunodeficiency virus (HIV) disease. However, the emergence of transmitted drug resistance (TDR) as a consequence of ART expansion represents a serious public health problem because TDR affects the treatment * Correspondence: [email protected] 2 Center for Infectious Diseases, Kobe University Graduate School of Medicine, Hyogo, Japan 5 Department of International Health, Kobe University Graduate School of Health Sciences, Hyogo, Japan Full list of author information is available at the end of the article
efficacy and clinical outcome [1,2]. Although the prevalence of TDR in resource-limited countries is currently
