Abstract

Background:
The presence of antiretroviral-resistant HIV-1 genetic variants in patients with late presentation to health care may impact the success of antiretroviral therapy, costs of care, and potential HIV transmission.
Aim:
To determine the prevalence of pre-treatment HIV-1 drug resistance to antiretrovirals (PDR) in Cuban patients classified as late presenters (LP).
Methods:
A retrospective cross-sectional study was carried out on 255 HIV-positive Cubans classified as LP (CD4+ T cell count ≤350 cells/mm3) and included in PDR surveillance studies in Cuba during the period 2009-2020. The viral subtype and the genotypic profile of antiretroviral resistance were analyzed. Some clinical and epidemiological variables were evaluated.
Results:
83.2% of the patients were male and 65.9% were men who had sex with other men (MSM). The average age was 31 years. 40% of the individuals studied had advanced disease (CD4+ T cell count ≤200 cells/mm3). The predominant genetic variants were subtype B (29.4%); CRF20, 23, 24_BG (24.3%) and CRF19_cpx (22.4%). The prevalence of PDR was 21.2% (95%, CI 16.3-26.7). The prevalence was 8.2% (95%, CI 5.3-11.9) for any Nucleoside Reverse Transcriptase Inhibitor (NRTI), 15.1 % (95%, CI 11.2-19.7) for any Non-Nucleoside Reverse Transcriptase Inhibitor (NNRTI), 2.1 % (95%, CI 0.75-4.41) for any Protease Inhibitor (PI). 9.25% of the LPs with PDR died a year after diagnosis of the HIV infection. The most frequent mutations were K103N (6.7%), G190A (4.7%) and M184V (4.3%). The treatment will not be effective in 17.3 % of patients who start therapy with the NRTI+NNRTI combinations.
Conclusion:
The high PDR values in LPs show the need to enhance genotypic studies of HIV resistance in this population at the time of diagnosis of the infection, since the success of first-line antiretroviral therapy may be compromised and influence compliance with the global goals set forth by UNAIDS for the year 2030.

Key words: Cuba, Late presenters, Resistance, Antiretroviral therapy, HIV