A Surveillance on Protease Inhibitor Resistance-Associated Mutations Among Iranian HIV-1 Patients

Background: Drug resistance is emerging as one of the greatest challenges in the development of effective treatment for HIV infection. The importance of clinical studies in this field stems from the world wide growing of treatment drug-resistant mutations. Objectives: This study was performed to determine the HIV subtype and the resistance mutations to the protease inhibitors in both untreated HIV patients and patients under treatment with protease inhibitors (PIs) in Iran. Methods: The study was conducted on two groups of participants. The first group consisted of 25 HIV patients who did not receive any antiretroviral treatment. The second group included 25 HIV patients who have being treated with a combination of protease inhibitors. After genome extraction, a nested polymerase chain reaction was performed to amplify the protease gene. Upon confirmation using electrophoresis, the amplicons or PCR products were sequenced and analyzed to determine the drug resistance mutations as well as the viral subtypes. Results: No mutations were found in the first group; however, 32% of the samples in the second group had PI related drug-resistance mutations. The major mutations were V82A and M46I, which were seen in 12% of the samples, while the minor mutation F53L was seen in 16% of the samples. The subtype analysis showed that 94% of the samples were subtype CRF35_AD, and 6% were of defined as subtype A. Conclusions: The present study reports updates on the mutations related to protease resistance in Iranian HIV patients receiving treatment. Our data, as well as existing reports, support the need for the optimization of treatment to prevent emergence of resistant viruses and a search for new antiretroviral drug candidates for HIV patients.