Abstract
We performed a pilot surveillance study on transmitted HIV drug resistance (TDR) in Iran, with specimens collected and stored as dried blood spots (DBS). The protease region and relevant positions in the reverse transcriptase region of the pol gene were sequenced to detect mutations known to be associated with resistance to drugs in standard first-line regimens. Seventy-three specimens were collected, with 39 (53%) specimens yielding sequence from both protease and at least part of RT. Specimens were almost exclusively HIV-1 subtype CRF 35_A1D based on pol sequencing. Mutations were restricted to RT, with D67DG and V75AV each seen in a single specimen. An atypical protease inhibitor mutation, I47M, appeared at a resistance-associated position in protease from a single specimen. These preliminary data showed that the rate of transmitted drug resistance in Iran, within the areas sampled, was 5.1% (2/39). However, the small sample size makes this figure only an approximation. Due to the sampling strategy and resulting small sample size, we were unable to accurately calculate TDR rates for individual areas using the WHO HIV drug resistance threshold survey method. Increasing the sample size and improving the yield from DBS would improve the accuracy of drug resistance surveillance and facilitate wider application of this methodology in Iran.
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References
(2006) HIV/AIDS national report of I.R. Iran. Ministry of Health, Center for Disease Control and Prevention, HIV/AIDS Office. (Persian)
(2005) Protocol for evaluation of transmitted HIV drug resistance using specimens from HIV sentinel serosurveys in resource-limited settings (draft). WHO HIV ResNet
Adje C, Cheingsong R et al (2001) High prevalence of genotypic and phenotypic HIV-1 drug-resistant strains among patients receiving antiretroviral therapy in Abidjan, Cote d’Ivoire. J Acquir Immune Defic Syndr 26(5):501–506
Bennett DE, Myatt M et al (2008) Recommendations for surveillance of transmitted HIV drug resistance in countries scaling up antiretroviral treatment. Antivir Ther 13(Suppl 2):25–36
Bertagnolio S, Soto-Ramirez L et al (2007) HIV-1 drug resistance surveillance using dried whole blood spots. Antivir Ther 12(1):107–113
Buckton AJ, Bissett SL et al (2008) Development and optimization of an internally controlled dried blood spot assay for surveillance of human immunodeficiency virus type-1 drug resistance. J Antimicrob Chemother 62(6):1191–1198
Day C, Nassirimanesh B et al (2006) Patterns of drug use among a sample of drug users and injecting drug users attending a General Practice in Iran. Harm Reduct J 3:2
Duwe S, Brunn M et al (2001) Frequency of genotypic and phenotypic drug-resistant HIV-1 among therapy-naive patients of the German Seroconverter Study. J Acquir Immune Defic Syndr 26(3):266–273
Garrido C, Zahonero N et al (2008) Subtype variability, virological response and drug resistance assessed on dried blood spots collected from HIV patients on antiretroviral therapy in Angola. J Antimicrob Chemother 61(3):694–698
Harris ME, Serwadda D et al (2002) Among 46 near full length HIV type 1 genome sequences from Rakai District, Uganda, subtype D and AD recombinants predominate. AIDS Res Hum Retroviruses 18(17):1281–1290
Kimura M (1980) A simple method for estimating evolutionary rate of base substitutions through comparative studies of nucleotide sequences. J Mol Evol 16:111–120
Larijani B, Zahedi F et al (2005) Medical ethics in the Islamic Republic of Iran. East Mediterr Health J 11(5–6):1061–1072
McNulty A, Jennings C et al (2007) Evaluation of dried blood spots for human immunodeficiency virus type 1 drug resistance testing. J Clin Microbiol 45(2):517–521
Naderi HR, Tagliamonte M et al (2006) Molecular and phylogenetic analysis of HIV-1 variants circulating among injecting drug users in Mashhad-Iran. Infect Agent Cancer 1:4
Razzaghi EM, Movaghar AR et al (2006) Profiles of risk: a qualitative study of injecting drug users in Tehran, Iran. Harm Reduct J 3:12
Richman DD, Morton SC et al (2004) The prevalence of antiretroviral drug resistance in the United States. AIDS 18(10):1393–1401
Sanders-Buell E, Saad MD et al (2007) A nascent HIV type 1 epidemic among injecting drug users in Kabul, Afghanistan is dominated by complex AD recombinant strain, CRF35_AD. AIDS Res Hum Retroviruses 23(6):834–839
Sarrami-Forooshani R, Das SR et al (2006) Molecular analysis and phylogenetic characterization of HIV in Iran. J Med Virol 78(7):853–863
Tagliamonte M, Naderi HR et al (2007) HIV type 1 subtype A epidemic in injecting drug user (IDU) communities in Iran. AIDS Res Hum Retroviruses 23(12):1569–1574
Vazirian M, Nassirimanesh B et al (2005) Needle and syringe sharing practices of injecting drug users participating in an outreach HIV prevention program in Tehran, Iran: a cross-sectional study. Harm Reduct J 2:19
Yerly S, Vora S et al (2001) Acute HIV infection: impact on the spread of HIV and transmission of drug resistance. AIDS 15(17):2287–2292
Zamani S, Kihara M et al (2006) High prevalence of HIV infection associated with incarceration among community-based injecting drug users in Tehran, Iran. J Acquir Immune Defic Syndr 42(3):342–346
Acknowledgment
This investigation received technical and financial support from the joint WHO Eastern Mediterranean Region (EMRO) and WHO Special Program for Research and Training in Tropical Diseases (TDR): The EMRO/TDR Small Grants Scheme for Operational Research in Tropical and other Communicable Diseases. We wish to especially thank Dr. Amal Bassili, Focal Point EMRO/TDR for her support the project, Dr. Jean Carr, Molecular Epidemiology Laboratory, Division of Epidemiology and Prevention, School of Medicine, University of Maryland for her helpful comments and editorial suggestions, and Mrs. Eshraghi, staff of WHO office in Tehran, for her kind cooperation in shipping the specimens to Canada. The authors wish to thank Drs. Abbas Sedaghat, Narges Mohammad Rezaei and Kianoosh Kamali in the HIV/AIDS office of CDC, Parviz Afshar, General Director of Health and Treatment, Iran Prisons Organization, and Noosh Darou Co. for providing Whatman DBS filter paper. The authors also wish to thank the technicians who collected the specimens.
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The authors declare that they had no competing interests.
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Mousavi, S.M., Hamkar, R., Gouya, M.M. et al. Surveillance of HIV drug resistance transmission in Iran: experience gained from a pilot study. Arch Virol 155, 329–334 (2010). https://doi.org/10.1007/s00705-009-0583-6
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DOI: https://doi.org/10.1007/s00705-009-0583-6