- Autores: Marta Pingarilho, Victor Pimentel, Mafalda N. S. Miranda, Ana Rita Silva, António Diniz, Bianca Branco Ascenção, Carmela Piñeiro, Carmo Koch, Catarina Rodrigues, Cátia Caldas, Célia Morais, Domitília Faria, Elisabete Gomes da Silva, Eugénio Teófilo, Fátima Monteiro, Fausto Roxo, Fernando Maltez, Fernando Rodrigues, Guilhermina Gaião, Helena Ramos, Inês Costa, Isabel Germano, Joana Simões, Joaquim Oliveira, José Ferreira, José Poças, José Saraiva da Cunha, Jorge Soares, Júlia Henriques, Kamal Mansinho, Liliana Pedro, Maria João Aleixo, Maria João Gonçalves, Maria José Manata, Margarida Mouro, Margarida Serrado, Micaela Caixeiro, Nuno Marques, Olga Costa, Patrícia Pacheco, Paula Proença, Paulo Rodrigues, Raquel Pinho, Raquel Tavares, Ricardo Correia de Abreu, Rita Côrte-Real, Rosário Serrão, Rui Sarmento e Castro, Sofia Nunes, Telo Faria, Teresa Baptista, Maria Rosario O. Martins, Perpetua Gomes, Luís Mendão, Daniel Simões, Ana Abecasis
- Ano de Publicação: 2022
- Journal: Frontiers in Microbiology
- Link: https://www.frontiersin.org/articles/10.3389/fmicb.2022.823208/full?&utm_source=Email_to_authors_&utm_medium=Email&utm_content=T1_11.5e1_author&utm_campaign=Email_publication&field=&journalName=Frontiers_in_Microbiology&id=823208
The “Treatment for All” program was implemented in many countries with an aim to offer treatment and care to anyone diagnosed with HIV, regardless of the stage of infection (CD4 cell count). In Portugal, this program was implemented in 2015 [World Health Organiztion (WHO), 2021]. The widespread use and increased coverage of antiretroviral therapy (ART) have reduced the risk of HIV transmission, decreased HIV-related morbidity and mortality, and improved life quality. However, treatment scale-up can potentiate the risk for the development of antiretroviral (ARV) drug resistance, which can be transmitted to newly infected individuals (Palella et al., 1998; Lima et al., 1999; Clavel and Hance, 2004; Cohen et al., 2011). TDR in HIV-1-infected patients has become a major concern as it may lead to the failure of first-line ART. There are several studies indicating that the prevalence of TDR is largely variable in different settings and risk groups and that this could be related to the differences in the availability of treatment and levels of socioeconomic development (Pennings, 2013; Frentz et al., 2014; Yang et al., 2015). For example, TDR levels are highly discrepant when we compare Germany (18.4%) (van de Laar et al., 2019)[9], Belgium (15.7%) (van de Laar et al., 2019)[9], Hungary (7.1%) (van de Laar et al., 2019)[9], Netherlands (12.3%) (van de Laar et al., 2019)[9], Mozambique (14.0% in women) (Pina-Araujo et al., 2014)[10], Latin America (7.7%) (Avila-Rios et al., 2016)[11], and Washington DC (20.0%) (Aldous et al., 2017)[12]. Portugal, on the other hand, presented an overall TDR of 9.4% between 2001 and 2017, with a significantly increasing trend from 7.9% in 2003 to 13.1% in 2017 (Pingarilho et al., 2020). These results were obtained in a retrospective study of our study group and were based only on RegaDB, a laboratory database including clinical, demographic, and genomic data of patients followed up in hospitals located in the southern region of Portugal.
As the HIV epidemic continues to spread, it is very important to investigate the prevalence and transmission of TDR over the years in individual settings/locations. Moreover, the phylogenetic analysis provides insight into the HIV transmission clusters (TCs). The characterization of HIV-1 transmission clusters and associated TDR allows for targeted interventions to individuals at higher risk.
In this study, we aim to describe TDR between 2014 and 2019 in newly diagnosed patients with HIV-1 in Portugal, characterize the most prevalent drug resistance mutations, and identify predictors of TDR in Portugal. Furthermore, we aim to characterize HIV-1 transmission clusters involving these patients.