HIV drug resistance testing is fundamental in clinical patient management, but data on HIV-1 drug-resistant mutations (DRMs) is scarce in the Caribbean and in Suriname limited to one survey on transmitted resistance. The aim of this study was to address this gap, to gain insight in acquired HIV drug resistance (ADR) prevalence and mutation patterns, and to improve HIV-1 treatment outcome of people living with HIV (PLHIV) in Suriname. A prospective cross-sectional study was conducted from July 2018 through January 2019 among treatment-experienced PLHIV (n = 72), with either treatment failure or antiretroviral therapy restart. Genotypic drug resistance testing was performed and DRM impact on drug effectiveness was examined. Genotypic drug resistance testing revealed 97.2% HIV-1 subtype B, 2.8% B/D recombinants and a ADR prevalence of 63.2% in treatment failure patients, with a predominance of nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations. The most common DRMs were M184V (23.6%) and K103N (18.8%). A high level of non-DRM polymorphisms was observed in both the reverse transcriptase (RT) and protease (PR) gene. Interesting deviations from the existing mutation datasets were noted at position E248 and R83 of the RT gene and L63 and V77 in the PR gene. Full susceptibility to all examined drugs was 54.2%, while high-level drug resistance was estimated at 37.5%, which seems promising for treatment outcomes for PLHIV in Suriname, although cross-resistance to next-generation NNRTIs was already estimated for nearly a quarter of the patients. The meager 2.9% of PR DRMs rendered protease inhibitors as an effective rescue HIV-1 treatment.

中文翻译：

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苏里南获得性 HIV-1 耐药性和突变模式的首次评估

HIV 耐药性检测是临床患者管理的基础，但在加勒比地区和苏里南，关于 HIV-1 耐药突变 (DRM) 的数据很少，仅限于一项关于传播耐药性的调查。本研究的目的是弥补这一差距，深入了解获得性 HIV 耐药性 (ADR) 流行和突变模式，并改善苏里南 HIV 感染者 (PLHIV) 的 HIV-1 治疗结果。一项前瞻性横断面研究于 2018 年 7 月至 2019 年 1 月在经历过治疗的 PLHIV ( n = 72)，治疗失败或重新开始抗逆转录病毒治疗。进行了基因型耐药性测试，并检查了 DRM 对药物有效性的影响。基因型耐药性测试显示，治疗失败患者中 HIV-1 亚型 B 为 97.2%，B/D 重组体为 2.8%，ADR 发生率为 63.2%，主要是非核苷逆转录酶抑制剂 (NNRTI) 突变。最常见的 DRM 是 M184V (23.6%) 和 K103N (18.8%)。在逆转录酶 (RT) 和蛋白酶 (PR) 基因中均观察到高水平的非 DRM 多态性。在 RT 基因的 E248 和 R83 位置以及 PR 基因的 L63 和 V77 位置注意到与现有突变数据集的有趣偏差。对所有检查药物的完全敏感性为 54.2%，而高水平耐药性估计为 37.5%，这对于苏里南 PLHIV 的治疗结果似乎很有希望，尽管已经估计近四分之一的患者对下一代 NNRTIs 存在交叉耐药性。微薄的 2.9% 的 PR DRM 使蛋白酶抑制剂成为有效的 HIV-1 拯救疗法。