Drug resistance-associated mutations in antiretroviral treatment-naive and -experienced patients in Kuwait

The identification of human immunodeficiency virus (HIV) mutations leading to drug resistance enables patient-specific adaptation of the treatment regimen and predicts the risk of transmission of drug-resistant HIV. In this study, we report for the first time the prevalence in Kuwait of non-polymorphic resistance-associated mutations (RAMs) in patients under first-line antiretroviral therapy. Viral RNA was extracted from plasma samples of 64 treatment-naive (untreated) and 64 treatment-experienced patients. The HIV-1 load was determined by real-time RT-PCR. The protease- and reverse transcriptase-encoding regions were analyzed by subtyping, and for drug resistance. The HIV-1 load at sampling in treatment-naive patients ranged from 1.61 x 10(4) to 1.91 x 10(6) copies/ml, whereas that in treatment-experienced patients ranged from <20 to 8.25 x 10(4) copies/ml (p <0.001). Ten different HIV-1 subtypes and recombinant forms were found with the predominance of CRF01_AE, B and C. Non-polymorphic mutations associated with resistance to antiretroviral drugs were detected in 8 treatment-naive patients (12.5%) and 11 treatment-experienced patients (28.9%; p = 0.46). RAMS detected in treatment-naive patients are known to be associated with resistance to non-nucleoside reverse transcriptase inhibitors (NNRTIs). Among treatment-experienced patients, five patients (13.1%) had mutations associated with high-level resistance to nucleoside reverse transcriptase inhibitors (NRTIs), 4 patients (10.5%) had mutations associated with resistance to NNRTIs, one patient (2.6%) had resistance to both NRTIs and NNRTIs, and one patient (2.6%) had resistance to both protease inhibitors (Pis) and NNRTIs. These results necessitate efforts to be made for reducing emergence of resistance-associated mutations in treated patients, and highlight the need for continuous monitoring of drug resistance patterns in Kuwait.