CCR5 Genotyping and Chemokine Receptor usage among HIV-1 Treatment - Naive and Experienced Patients in India

The reverse transcriptase and protease- inhibitors form the backbone of the AIDS control programme in India. Increasing reports on transmitted and second line antiretroviral resistance alarms the need for new drugs that could be used for effective patient management. In 2007, the Food and Drug Administration approved the use of CCR5 antagonist in HIV-1 infected treatment experienced patients. Thus, we aimed to determine the clinical feasibility of using CCR5 antagonist in HIV- 1 infected treatment naïve (n=23) and experienced (n=22) patients. Cotropism testing, CCR5 genotyping and mutational resistance profile for first - and second line antiretroviral drugs were determined for each patient. None of the patients (0%, 0/45) conferred mutant CCR5 genotype. HIV-1 subtype ‘C' was found to be predominant in 95.6% (43/45, 95% CI:84- 100) patients, while 4.4% patients (2/45, 95% CI:0-16) were infected with circulating recombinant forms. Mutational testing reported 43.4% (10/23, 95% CI:26-63) treatment naive and 36.3% (8/22, 95% CI:20-57) treatment experienced patients to confer first - and/or second- line antiretroviral drug resistance. Further, cotropism testing revealed use of R5 coreceptor for viral entry in 80% (8/10, 95% CI:48-95) treatment naive and 37.5% (3/8, 95% CI:13-70) treatment experienced drug resistant patients; indicating CCR5 antagonists should be considered for treating HIV-1 infected patients in India.