Case report: transmission of a three-drug-class resistant variant of HIV-1 to a naive patient in Argentina

A. PETRONI,; A. MARANZANA,; G. DELUCHI; M. GOMEZ CARRILLO; J BENETUCCI,

Mexico DF Mexico

Congreso; XVII International AIDS Conference; 2008

International Aids Society

Background: Transmission of antiretroviral-resistant HIV-1 to naive patients is well established. However, transmission of multiresistant (¡Ý3 drug classes) variants is a rare event. Methods: Patient P128 is a 45-year-old woman who had two HIVnegative serologies in February and March 2007 and became HIVpositive  in September 2007. She was enrolled in a surveillance study on primary resistance (recently infected patients) conducted at FUNDAI since 2004. Data on her partner (Source patient) was obtained at enrollment: a 46-year-old HIV-positive (AIDS) man diagnosed in 1997 who received antiretroviral treatment since 1998 (adherence of about 70%). He received three previous drug-schemes and, since November 2005, saquinavir/r, lamivudine, abacavir, tenofovir and enfuvirtide. Since October 2006, RP128 had unprotected sexual contacts only with her partner. Viral RNA from plasma was retrotranscribed and a fragment of the pol gene [protease and the first 335 codons of the reverse transcriptase (RT)] was sequenced. Drug susceptibility was inferred with the Stanford Database. Phylogenetic and recombination (bootscanning) analyses were implemented with ClustalX and Simplot, respectively. Viral load (VL) was determined by RT-PCR. Results: In October 2007, VL of patient RP128 was 160 RNA copies/ml (CD4, 738 cells/mm3). Then, genotyping was performed in November 2007 (VL of 3119 copies/ml). The RP128 virus showed resistance to all nucleoside RT inhibitors (M41L, D67N, K70R, V75L, M184M/V, T215Y, K219E), non-nucleoside RT inhibitors (L100I, K103N) and protease inhibitors (L10I, G16E, K20R, M36I, I54V, G73C, I84V, L90M, I93L). The same three-drug-class resistant profile was found in a genotypic test of the Source patient [November 2007; VL increased from 7862 (May 2006) to 49088 copies/ml (May 2007)]. RP128 and Source viruses (B/F recombinants, CRF12_BF-like) showed 98.0% identity and 24/26 nucleotide differences were mixtures that included the nucleotide found in the other sequence. Conclusions: This is the first report on transmission of a three-drugclass resistant virus to a naive patient in Argentina.Transmission of antiretroviral-resistant HIV-1 to naive patients is well established. However, transmission of multiresistant (¡Ý3 drug classes) variants is a rare event. Methods: Patient P128 is a 45-year-old woman who had two HIVnegative serologies in February and March 2007 and became HIVpositive  in September 2007. She was enrolled in a surveillance study on primary resistance (recently infected patients) conducted at FUNDAI since 2004. Data on her partner (Source patient) was obtained at enrollment: a 46-year-old HIV-positive (AIDS) man diagnosed in 1997 who received antiretroviral treatment since 1998 (adherence of about 70%). He received three previous drug-schemes and, since November 2005, saquinavir/r, lamivudine, abacavir, tenofovir and enfuvirtide. Since October 2006, RP128 had unprotected sexual contacts only with her partner. Viral RNA from plasma was retrotranscribed and a fragment of the pol gene [protease and the first 335 codons of the reverse transcriptase (RT)] was sequenced. Drug susceptibility was inferred with the Stanford Database. Phylogenetic and recombination (bootscanning) analyses were implemented with ClustalX and Simplot, respectively. Viral load (VL) was determined by RT-PCR. Results: In October 2007, VL of patient RP128 was 160 RNA copies/ml (CD4, 738 cells/mm3). Then, genotyping was performed in November 2007 (VL of 3119 copies/ml). The RP128 virus showed resistance to all nucleoside RT inhibitors (M41L, D67N, K70R, V75L, M184M/V, T215Y, K219E), non-nucleoside RT inhibitors (L100I, K103N) and protease inhibitors (L10I, G16E, K20R, M36I, I54V, G73C, I84V, L90M, I93L). The same three-drug-class resistant profile was found in a genotypic test of the Source patient [November 2007; VL increased from 7862 (May 2006) to 49088 copies/ml (May 2007)]. RP128 and Source viruses (B/F recombinants, CRF12_BF-like) showed 98.0% identity and 24/26 nucleotide differences were mixtures that included the nucleotide found in the other sequence. Conclusions: This is the first report on transmission of a three-drugclass resistant virus to a naive patient in Argentina.