Resistance in non-B HIV subtypes

It is estimated that one quarter of HIV-infected people in the United Kingdom have contracted a non-B subtype. Such infections are found almost exclusively among people who have contracted HIV through heterosexual sex.

A British study of over 600 people born in the United Kingdom or Europe found that 14% of the men and 35% of the women were infected with non-B subtypes. 1 Many clinics in metropolitan cities across Europe now routinely report 25 to 40% of their patient profile as having non-B clade virus, including London-based hospitals.

Due to the preponderance of the B subtype in western countries, resistance research has focused on the evolution and mutations associated with the B subtype. Little is known about how drug resistance may evolve differently in people infected with non-B subtypes, although this is a growing area of interest. Just over 90% of all HIV-1 infections are non-subtype B variants.2

There is increasing recognition of the impact subtype has on pathways to resistance during HIV treatment. There is also recognition of the need for further research in non-B subtypes to inform the treatment decisions of people with non-B subtypes and the analysis of their resistance assays.

The results of a genotypic interpretation algorithm will vary by subtype. The extent to which specific subtype-dependent mutations influence response to therapy is not fully understood.3

References

  1. Parry JV et al. National surveillance of HIV-1 subtypes for England and Wales: design, methods, and initial findings. J Acquir Immune Defic Syndr 26: 381-388, 2001
  2. Martinez-Cajas J et al. Differences in resistance mutations among HIV-1 non-subtype B infections: a systematic review of evidence (1996-2008). J Int AIDS Soc 12(1): 11, 2009
  3. Snoeck J et al. Discordances between interpretation algorithms for genotypic resistance to protease and reverse transcriptase inhibitors of human immunodeficiency virus are subtype dependent. Antimicrob Agents Chemother 50(2): 694-701., 2006
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