International journal of infectious diseases : IJID : official publication of the International Society for Infectious Diseases 2017 11 08() pii 10.1016/j.ijid.2017.10.020
The objective of this review is to assess the burden of HIV drug resistance mutations (DRM) in Indian adults exposed to first-line ART as per national guidelines.
We performed advanced search for the published literature on HIV drug resistance in India in PubMed and Scopus. From each publication data pertaining to age, sex, CD4 count and viral load, prevalence of NRTI/NNRTI drug resistance mutations (DRM) was extracted. Year-wise Indian HIV-1 reverse transcriptase (RT) sequences were retrieved from Los Alamos HIV database and mutation analyses were performed. Time trend analysis of proportion of sequences showing NRTI resistance mutations among individuals exposed to first-line ART was performed.
Overall 23 studies and 1046 RT unique sequences were identified indicating prevalence of drug resistance against nucleoside reverse transcriptase inhibitors (NRTI) and non-nucleoside reverse transcriptase inhibitors (NNRTI). The proportion of RT sequences with any DRM, any NRTI DRM and any NNRTI DRM were 78.39%, 68.83% and 73.13% respectively. Temporal trend analysis of individual DRM from sequences retrieved from 2004 to 2014 indicated rising trend of K65R mutations (p=0.013).
Although, the overall burden of resistance against agents of first-line ART has remained steady over past decade, periodic monitoring is essential. There is need to develop HIV-1 Subtype C specific resistance database in India.