Neuropathy among drug resistant HIV Patients treated in Jakarta

Some people living with HIV (PLWH) receiving ART in Indonesia display poor clearance of replicating virus. This has been associated with HIV-associated sensory neuropathy. Here we assess whether treatment failure reflects the presence of drug resistance mutations.

PLWH were stratified by HIV RNA levels using a ≥ 1000 copies/mL cut-off after 5.3 (2-7.5) years on ART. Drug-resistance mutations were analyzed in seven of ten cases with a detectable viral load. The HIV pol gene was screened for mutations affecting resistance to nucleoside inhibitors (NRTI), non-nucleoside inhibitors (NNRTI) and protease inhibitors (PI). We recorded co-infections, transmission routes, and neuropathy based on the Brief Peripheral Neuropathy Screen Tool.

The primary HIV subtype was HIV-1 CRF01_AE, but one patient had subtype G. Polymorphisms affecting NRTI or NNRTI (6/7 cases) and protease inhibitors (1/7 cases) were identified. Three mutations affecting NRTI (M184V, M4IL, T215F), two for NNRTI (K103N, G190A) and five for protease inhibitors (M46I, I50V, I54V, V82A, N88NDGS) were evident. Subjects with resistance mutations were mostly intra-venous drug users (4/7) and had a higher risk of neuropathy (p = 0.016).

Drug resistance mutations were present in most cases of treatment failure examined and were therefore indirectly a risk factor for peripheral neuropathy.