A national cross-sectional analysis of surveillance drug resistance mutations among recently diagnosed antiretroviral naïve Brazilian people with HIV.
cross_sectional · Level IV
Where this comes from
- Record sourced from PubMed, PMID 41255959.
- Also identified by DOI 10.1016/j.lana.2025.101283 and PMC identifier 12621447.
- Licence recorded as CC BY-NC-ND.
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Abstract
Brazil pioneered free and universal HIV antiretroviral therapy (ART) access in 1996. This study evaluated the prevalence of surveillance drug resistance mutations (SDRM) among individuals newly diagnosed with HIV and initiating ART. Using WHO HIV Threshold Survey methodology, participants were recruited from seven major cities, representing all Brazilian macro-regions. Dried blood spots collected between August 2021 and November 2023 were transported at room temperature to a central laboratory for genotyping. A total of 327 samples were analyzed, 271 (82.9%) were males. The self-reported ethnic distribution was obtained from 257 people, including 92 white (35.8%), 115 brown (44,7%), 46 black (17.9%), 2 indigenous (0.8%), and 2 Asian (0.8%) people. Mean/median CD4+ T-cell counts were 377/325 cells/μL, and mean/median viral load was 468,000/71,800 copies/mL. Overall SDRM prevalence was 11.6%, with regional values of 16.0% (Rio de Janeiro), 11.5% (Santos), 13.0% (Belém), 11.6% (Porto Alegre), 10.6% (Itajaí), 10.6% (Brasília), and 9.0% (Salvador). Resistance prevalence by class was 3.4% for nucleoside reverse transcriptase inhibitors, 5.2% for non-nucleoside reverse transcriptase inhibitors, 1.5% for protease inhibitors, and 1.8% for integrase strand transfer inhibitors (INSTI). One individual harbored the dolutegravir-associated R263K mutation. Compared to a prior survey conducted a decade earlier, subtype C prevalence increased markedly, and a probable new circulating recombinant form was detected. Nationwide SDRM prevalence in Brazil remains stable relative to data from 10 years ago. However, the emergence of low-level INSTI SDRM, including dolutegravir-specific resistance, is noteworthy. These results emphasize the importance of continuous SDRM and HIV genetic diversity surveillance. Sustained molecular monitoring is essential for optimizing prevention strategies and preserving long-term treatment effectiveness. FAPESP and CNPq.