new drug resistance mutations of reverse transcriptase human immunodeficiency virus type-1 gene in first-line antiretroviral-infected patients in west sumatra, indonesia

Background ― Antiretroviral (ARV) therapy has successfully reduced the transmission, morbidity, and mortality of Human immunodeficiency virus 1 (HIV-1) infection, but the appearance of drug resistance mutations (DRMs) is an obstacle to successful HIV management. DRMs against nucleoside reverse transcriptase inhibitors (NRTIs) and non-nucleoside reverse transcriptase inhibitors (NNRTIs) have never been analyzed and reported in HIV-1 patients in Padang (West Sumatra, Indonesia). Objective ― This study aimed to identify NRTI- and NNRTI-DRMs from HIV-1 proviral deoxyribonucleic acid (DNA) in HIV-infected patients who had received ARV therapy for >12 months at the Dr. M. Djamil General Hospital in Padang. Material and Methods ― We isolated HIV-1 proviral DNA from blood samples from 105 HIV-1 patients who had undergone first-line ARV therapy for >12 months. Isolates were amplified via a nested PCR technique using two primer-specific types of reverse transcriptase (RT). The amplicon was electrophoresed on 0.8% agarose gel and then sequenced. Analysis of DRMs in the HIV-1 RT genes was based on the Standford HIV database. Results ― The 17 isolates from 105 ARV-treated patients, eight RT genes were successfully sequenced, and DRM of RT inhibitors was found in one of the isolates (12.5%). The Stanford HIV database analysis detected three new DRMs at the 184th, 215th and 190th codon positions, causing three mutations: M184L and T215N (NRTI-DRMs) with low-level resistance to zidovudine, and G190D (NNRTI-DRM). Conclusion ― We concluded that the new DRMs found in Padang, West Sumatra indicates the importance of genotypic resistance testing and the periodic evaluation of the effectiveness of ARV drugs currently in use.