Background : The prevalence of HIV drug resistance mutations in drug-naive patients has been shown to differ with geographic origin. The purpose of this study is to assess the prevalence of transmitted antiretroviral drug resistance mutations in drug-naive patients in Korea. Methods : Genotypic resistance was determined by the use of the Viroseq Genotyping System in 42 antiretroviral treatment naive HIV-infected patients between March 2005 and July 2006. Transmitted drug resistance was estimated according to the IAS-USA 2005 definition, taking into account only major mutations in the protease and all mutations in the reverse transcriptase, including revertant mutations at codon 215. Results : The median age of the patients was 42 years and 37 (88%) were male. The median CD4+T cell count was 136/mm3 and the mean plasma RNA level was 4.98 log copies/mL. Among 42 patients studied, 37 (88%) were newly diagnosed patients. None of the patients were recent seroconverters; 38 patients (90%) were infected with subtype B and 4 patients were infected (10%) with the non-B subtype strains (2 patients with CRF01-AE 1 as CRF02-AG; 1 patient with subtype A). Of the 42 subjects tested, we found 2 (4.8%) mutations in NRTI (V118I), but did not find a mutation in NNRTI as well as in the PI region. Conclusions : The prevalence of transmitted antiretroviral drug resistance in drug-naive patients is still low in Korean patients.(Korean J Med 73:243-250, 2007)

목적 : 최근 내원한 치료력이 없는 사람면역결핍바이러스 감염환자에서 전파된 내성바이러스의 빈도를 알아보고자 하였다. 방법 : 2005년 3월 1일부터 2006년 7월 30일까지 부산대학교병원에 처음 내원한 사람면역결핍바이러스 감염 환자 중 항레트로바이러스제 치료력이 없는 환자들을 대상으로 하였다. HIV-1 유전형 내성 검사는 ViroSeqTM HIV-1 Genotyping System을 사용하였다. 유전형 내성은 International AIDS Society-USA panel의 2005년 합의 지침을 근거로 하여 한 가지 이상의 내성관련 돌연변이가 존재할 때로 정의하였으며, 유전적 아형은 pol 유전자 염기서열을 염기서열분석 프로그램(REGA HIV-1 Subtyping Tool - Version 2.0 과 NCBI Blast genotyping tool)을 이용하여 분석하였다. 결과 : 대상 기간 중 42명의 환자에서 유전형 내성 검사가 시행되었다. 환자들의 평균 나이는 42세였으며 남자 37명(88%), 여자가 5명(12%)이었다. 정중 CD4 세포수는 136/mm3, 평균 혈장 HIV-1 RNA 정량 검사 결과 역가는 4.98 log copies/mL이었다. 유전적 아형은 B형이 38명이었으며 CRF01 AE 2명, CRF02 AG 1명 및 A 형이 1명이었다. 42명 중 2 (4.8%)명에서 뉴클레오시드 역전사효소 억제제(NRTI)에 내성관련 돌연변이가 존재하였으며(V118I), 비뉴클레오시드 역전사효소 억제제 내성과 단백분해효소 억제제에 주 내성인 경우는 없었다. 42명 중 37명(88%)은 발견된 지 1년 미만이었으며, 이들에서 유전형 내성 빈도는 약 4.8%이었다. V118I를 제외하면 NRTI 내성도 없었다. 결론 : 이전 치료력이 없는 사람면역결핍바이러스 감염 환자에서 유전형 내성 빈도는 약 4.8%였다. V118I를 제외하면 전파된 고도내성은 없었다.

Background : The prevalence of HIV drug resistance mutations in drug-naive patients has been shown to differ with geographic origin. The purpose of this study is to assess the prevalence of transmitted antiretroviral drug resistance mutations in drug-naive patients in Korea. Methods : Genotypic resistance was determined by the use of the Viroseq Genotyping System in 42 antiretroviral treatment naive HIV-infected patients between March 2005 and July 2006. Transmitted drug resistance was estimated according to the IAS-USA 2005 definition, taking into account only major mutations in the protease and all mutations in the reverse transcriptase, including revertant mutations at codon 215. Results : The median age of the patients was 42 years and 37 (88%) were male. The median CD4+T cell count was 136/mm3 and the mean plasma RNA level was 4.98 log copies/mL. Among 42 patients studied, 37 (88%) were newly diagnosed patients. None of the patients were recent seroconverters; 38 patients (90%) were infected with subtype B and 4 patients were infected (10%) with the non-B subtype strains (2 patients with CRF01-AE 1 as CRF02-AG; 1 patient with subtype A). Of the 42 subjects tested, we found 2 (4.8%) mutations in NRTI (V118I), but did not find a mutation in NNRTI as well as in the PI region. Conclusions : The prevalence of transmitted antiretroviral drug resistance in drug-naive patients is still low in Korean patients.(Korean J Med 73:243-250, 2007)

HIV, Antiretroviral agent, Drug resistance