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HIV-1 Molecular Epidemiology and Drug Resistance in India Ujjwal Neogi St. Johns Medical College and Hospital, Bangalore, India II EuResist INTERNATIONAL MEETING, 6 th May 2011 Bonn, Germany Summary of the talk Molecular Epidemiology

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HIV-1 Molecular Epidemiology and Drug Resistance in India

Ujjwal Neogi

St. John’s Medical College and Hospital,

Bangalore, India

II EuResist INTERNATIONAL MEETING, 6th May 2011 Bonn, Germany

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Summary of the talk

Molecular Epidemiology of HIV Subtypes in India.
Drug resistant genotyping
EuResist study: INDIA (Preliminary Observations)

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First Case of HIV/AIDS

First Case of HIV/AIDS identified among the commercial sex worker in Tamilnadu, southern Part of India.

NACO Annual Report, 2009-10

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NACO Annual Report, 2009-10

Trends in HIV Incidence

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Mode of Transmission

NACO Annual Report, 2009-10

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HIV-1 Molecular Epidemiology in India

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HIV-1 Molecular Epidemiology

Subtype C

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94%

Prevalence of HIV-1 Subtypes in India*

* Based on Data available in Los Alamos Database

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Trends in HIV-1 Molecular Epidemiology in India

Neogi et al, unpublished N=1374

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Neogi et al 2009, IJEB

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Study Sites

PGIMER, Punjab NII, New Delhi

RIMS,

Manipur

RDG Medical

College, Ujjain

KR Hospital, Mysore
SJMC, Bangalore

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Till Jan, 2011

Current Cohort:

N=143

* Data based on two gene sequences/patients

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Region wise distribution of HIV-1 subtypes

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Drug Resistance Genotyping

First I want you to get genotype test done to check resistance

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Drug Resistance Genotyping: Transmitted Drug Resistance

 Major DRM: None  Accessory/minor DRM: 9.56% (E138A, L210LS)  Polymorphisms Neogi et al 2010, AIDS Res Hum Retroviruses

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Neogi et al; unpublished

Drug Resistance Profile: ART Experienced Patient with VL >1000 copies/ml (n=92)

NRTI NNRTI

Acquired Drug Resistance

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Selection of NNRTI Mutations: (n=92)

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Cross-resistance to Etravirine

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INDIA

(Preliminary Observations)

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EuResist Prediction:

ART Naïve Group: 50 Adults ready to initiate ART. ART Experienced Group: 70 Adults on ART and viral load >1000 copies/ml.

Patient Demography, Clinical and genetic parameter fed into EuResist Engine: 1.Sequence/Mutation Profile 2.Drugs to be used to build the treatment regimen 3.Patient past reg imen

4. Viral load, CD4 count, Age, Sex, mode of transmission.

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First Line Regimen

NACO Regimen: AZT/D4T+3TC +NVP/EFV

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Neogi et al; unpublished

Second Line Regimen

NACO Regimen: TDF+AZT+3TC +LPV/r

N=70

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What are the other options??

Co-receptor Antagonist !!!!!

Neogi et al 2010, AIDS Res Ther

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 Subtype C is predominant but recombinant forms are in increasing  The level of transmitted drug resistance in India is <5%. Evolution of RT region is sluggish.  Cross-resistance to ETR and the pattern of NNRTI-mutations in nevirapine-exposed patients suggests that use of nevirapine as first- line NNRTI in resource constrained settings may be reconsidered.  CCR5 antagonist may work better in India as conserved co- receptor usage were identified in Indian C strains.

Summary

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Acknowledgements

Dr. Anita Shet, SJMC
Dr. Ayesha De Costa, KI

Lab Members: Mr. Soham Gupta, Ms. Pravat Nalini Sahoo, Ms. Shwetha D Rao, Mr. Raj Mahendran

Prof. Anders Sonnerborg, KI
Dr. Maria L Ekstrand, UCSF (PI-

Prerana Study) HIVIND and Prerana Study Team National AIDS Control Organization Indian Council of Medical Research, NIH and EU FP7 Our patients

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