HIV Drug Resistance after Failure of 6 Month First-line Therapy in a Hospital: A Case Series

Ardiana Kusumaningrum, Fera Ibrahim, Evy Yunihastuti, Budiman Bela


This is the first report of HIV drug resistance in RSUPN Dr. Cipto Mangunkusumo. We tested We reviewed eleven new cases of HIV patients who had virologic failure after 6 months first-line antiretroviral therapy. With the sequencing method, analysis of gene mutations encoded HIV drug resistance. Genotypic resistance results and HIV-1 subtype were interpreted by Stanford DR database. Of ten plasma samples that were successfully amplified and sequenced, all samples were resistant to at least one antiretroviral drug. Genotypic resistance towards the antiretroviral drugs being used was observed in lamivudine (90%), tenofovir (83%), nevirapine (100%) dan efavirenz (100%). It is interesting that no zidovudine resistance were found, including in four patients receiving zidovudine in their HAART. The common NRTI mutations were M184VI and K65R, while NNRTI mutations were Y181CFGVY, K103N, A98AG, E138GQ and G190AGS. No mayor PI mutations were found. Based on these findings, we supports the need for appropriate virology monitoring and HIV drug resistance survey in clinical practice and access to drug options in case of virology failure.


HIV drug resistance; virologic failure; HIV-1


Anonim. Statistik Kasus HIV/AIDS di Indonesia. Ditjen PP & PL Kemenke RI. 2013.

Murray PR, Baron EJ, Jorgensen JH, et al. Manual of clinical microbiology 9th edition. ASM Press. 2007.

Boyer S, March L, Kouanfack C, et al. Monitoring of HIV viral load, CD4 cell count, and clinical assessment versus clinical monitoring alone for antiretroviral therapy in low-resource settings (Stratall ANRS 12110/ESTHER): a cost-effectiveness analysis. Lancet Infect Dis. 2013;13:577-86.

Budayanti NNS. Disertasi: Basis molekuler penanda resisten antiretrovirus dan polimorfisme gen protease – reverse transcriptase Human Immunodeficiency Virus-1 subtipe CRF01¬_AE pada penderita naïve dan gagal terapi di Bali. Universitas Udayana. 2012.

Merati TP, Ryan CE, Spelmen T, et al. CRF01_AE dominates the HIV-1 epidemic in Indonesia. Sex Health. 2012;9(5):414-21.

Widiyanti M, Wibawa T, Wibowo HA. Subtypes and phylogenetic analysis of human immunodeficiency virus-1 in Jayapura. Univ Med. 2014;33:49-57.

Barth RE, van der Loeff MFS, Schuurman R, et al. Virological follow-up of adult patients in antiretroviral treatment programmes in sub-Saharan Africa: a systematic review. Lancet Infect Dis. 2010:10(3):155-66.

Chaplin B, Eisen G, Idoko J, et al. Abstract: Impact of HIV type 1 subtype on drug resistance mutations in Nigerian patients failing first-line therapy. AIDS Research and Human Retroviruses. 2011;27(1):71-80.

Wang J, He C, Hsi JH, et al. Virological outcomes and drug resistance in Chinese patients after 12 Months of 3TC-based first-line antiretroviral treatment, 2011 – 2012. PLoS ONE. 2013;9(2):e88305.

Pham QD, Huynh TKH, Luong TT, et al. HIV-1 drug resistance and associated factors among adults failing first-line highly active antiretroviral therapy in Ho Chi Minh City, Vietnam. HIV Clin Trials. 2013;14(1):34-44.

Hamers RL, Sigaloff KCE, Wensing AM, et al. Patterns of HIV-1 drug resistance after first-line antiretroviral therapy (ART) failure in 6 sub-saharan African Countries : implications for second-line ART strategies. Clin Infect Dis. 2012;54(11):1660-9.

Lie´geois F, Vella, C, Eymard-Duvernay S, et al. Virological failure rates and HIV-1 drug resistance patterns in patients on first-line antiretroviral treatment in semirural and rural Gabon. J Int AIDS Soc. 2012;15:17985.

Tambuyzer L, Azijn H, Rimsky LT, et al. Compilation and prevalence of mutations associated with resistance to non-nucleoside reverse transcriptase inhibitor. Antiviral Therapy. 2009;14:103-9.

Ariribas JR, Pozniak AL, Gallant JE, et al. Abstract: Tenofovir disoproxil fumarate, emtricitabine, and efavirenz compared with zidovudine/lamivudine and efavirenz in treatment-naïve patients: 144-week analysis. J Acquired Immune Deficiency Syndr. 2008;47(1):74-8.

Von Wyl V, Cambiano V, Jordan MR, et al. Antiretroviral therapy in setting without virological monitoring. PLoSONE. 2012;7(8):e42834.

Marconi VC, Sunpath H, Lu Z, et al. Prevalence of HIV-1 drug resistance after failure of a first highly active antiretroviral therapy regimen in KwaZulu Natal, South Africa. Clin Infect Dis. 2008;46:1589-97.

Gupta RK, Hill A, Sawyer AW, et al. Virological monitoring and resistance to first-line highly active antiretroviral therapy in adults infected with HIV-1 treated under WHO guidelines: a systematic review and meta-analysis. Lancet Infect Dis. 2009;9:409–17.

Ngo-Giang-Huong N, Jourdain G, Amzal B, et al. Resistance patterns selected by nevirapine vs. efavirenz in HIV-infected patients failing first-line antiretroviral treatment: a bayesian analysis PLoS ONE. 6(11): e27427. doi:10.1371/journal.pone.0027427.

Singh K, Flores JA, Kirby KA, et al. Review: Drug resistance in non-B subtype HIV-1: impact of HIV-1 reverse transcriptase inhibitors. Viruses. 2014;6(9): 3535–62.

Ibe S, Sugiura W. Clinical significance of HIV reverse transcriptase inhibitor resistance mutations. Future Microbiol. 2011;6(3):295-315.

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