Pretreatment HIV Drug Resistance and Virologic Outcomes to First-Line Antiretroviral Therapy in Peru

Jaime Soria, Raquel Mugruza, Molly Levine, Segundo R. León, Jorge Arévalo, Eduardo Romulo Ticona Chavez, Ingrid A. Beck, Lisa M. Frenkel

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Access to nucleoside reverse transcriptase inhibitor (NRTI) and non-nucleoside reverse transcriptase inhibitor (NNRTI) first-line antiretroviral therapy (ART) for HIV has been increasing in Peru since a national ART program was initiated in 2004. Between 2007 and 2009, we found a 1% prevalence of pre-ART HIV drug resistance (PDR) among antiretroviral (ARV)-naive Peruvians. Given that PDR has been associated with virologic failure (VF) of ART, in 2014-2015 we enrolled a follow-up cohort at the same institution to determine whether the rate of transmitted resistance had increased and compared virologic outcomes of those with and without PDR. Blood specimens from ARV-naive individuals were assessed for PDR to NNRTI-based ART by an oligonucleotide ligation assay (OLA) sensitive to 2% mutant within an individual's HIV quasispecies at reverse transcriptase codons M41L, K65R, K103N, Y181C, M184V, and G190A, and by Sanger consensus sequencing (CS). Rates of VF (plasma HIV RNA >200 copies/mL) were compared between those with and without PDR. Among 122 ARV-naive adults, PDR was detected by OLA in 17 (13.9%) adults. Compared with the 2007-2009 cohort, the proportion with PDR at OLA codons was significantly increased (p <.001). A total of 11 of 19 OLA mutations conferring high-level drug resistance were also detected by CS, and 8 additional participants had mutations encoding low-level resistance detected by CS for a total of 25 participants (20.5%). VF at month 6 of NNRTI-ART appeared greater in participants with versus without PDR [4/18 (22.2%) vs. 3/71 (4.2%); p =.03]. An increasing prevalence of PDR was detected among ARV-naive Peruvians. Studies are needed to determine risks of specific PDR mutations.

Original languageEnglish
Pages (from-to)150-154
Number of pages5
JournalAIDS Research and Human Retroviruses
Issue number2
StatePublished - Feb 2019
Externally publishedYes

Bibliographical note

Funding Information:
Funds for this work came from the following organizations: National Institutes of Health, P30 AI027757 and UM1 AI106716 (L.M.F.), and The HIV Research Trust ( J.S.). The remaining authors have no conflicts to declare.

Funding Information:
The study team acknowledges and appreciates the participants’ dedication to the study. This study was supported by The HIV Research Trust (HIVRT), CFAR P30 AI027757, and IMPAACT UM1 AI106716 awards.


  • antiretroviral-naive
  • HIV
  • oligonucleotide ligation assay
  • Peru
  • pre-ART HIV drug resistant

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