Nce mutationsMutation Nondrug users ART (-), n = 21 L90M + K20R
Nce mutationsMutation Nondrug users ART (-), n = 21 L90M + K20R 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (7.1) 8 (38.1) 2 (9.5) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 1 (7.1) 0 (0.0) 0 (0.0) 2 (9.5) 0 (0.0) ART (+), n = 32 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 0 (0.0) 5 (15.6) 0 (0.0) 2 (6.3) 2 (6.3) 0 (0.0) 1 (3.1) 0 (0.0) 1 (3.1) 3 (9.4) 0 (0.0) 1 (3.1) Injection drug users ART (-), n = 32 0 (0.0) 1 (3.1) 0 (0.0) 0 (0.0) 1 (3.1) 1 (3.1) 0 (0.0) 5 (15.6) 2 (6.3) 1 (3.1) 0 (0.0) 0 (0.0) 0 (0.0) 1 (3.1) 2 (6.3) 0 (0.0) 0 (0.0) 0 (0.0) ART (+), n = 47 1 (2.1) 0 (0.0) 1 (2.1) 1 (2.1) 0 (0.0) 0 (0.0) 1 (2.1) 7 (8.5) 3 (6.4) 0 (0.0) 0 (0.0) 1 (2.1) 0 (0.0) 0 (0.0) 2 (4.3) 0 (0.0) 0 (0.0) 0 (0.0)D30N + T74S + K20R D30N + M46I + K20I G48E K20I K20R L10I L10V L33F V32L I13V + L63P L10I + K20R L10V + K20R L10V + T74S L10V + V11I G48RD30N + M46I + G48EL33F + A71TData presented are number and proportion of subjects. Mutations are denoted based on Stanford drug resistance database and International Antiviral Society-USA drug resistance mutations panel [12, 39, 40], where number shows amino acid DecumbinMedChemExpress Decumbin position in the protease gene, and letter before position is wild type amino acid and after the position mutant amino acid Major mutations are shown in bold A alanine, D aspartic acid, E glutamic acid, F phenylalanine, G glycine, I isoleucine, K lysine, L leucine, M methionine, N asparagine, P proline, R arginine, S serine, T threonine, V valine, ART (-) antiretroviral treatment-naive, ART (+) antiretroviral treatment-experienced, HIV-1 human immunodeficiency virus type-(3.1 ) G48E, 1 (3.1 ) G48R, 5 (15.6 ) K20R, 2 (6.3 ) L10I, 1 (3.1 ) L10V, 1 (3.1 ) L101+K20R and 2 (6.3 ) L10V + K20R. In non-drug users, 15 (46.9 ) ART-experienced individuals had minor mutations consisting of(15.6 ) K20R, 2 (6.3 ) L10V, 2 (6.3 ) L33F, 1 (3.1 ) I13V + L63P, 1 (3.1 ) L10V + K20R, 3 (9.4 ) L10V + T74S and 1 (3.1 ) L33F + A71T. In addition, 14 (66.7 ) ART-naive non-drug users harboured minor mutations comprising of 1 (7.1 ) K20I, 8 (38.1 ) K20R,Budambula et al. AIDS Res Ther (2015) 12:Page 5 of2 (9.5 ) L10I, 1 (7.1 ) L101 + K20R, and 2 (9.5 ) L10V + V11I.Association of protease inhibitor resistance with viral load and CD4+ T cell countsViral load and CD4+ T cell counts of individuals with major and minor mutations are presented in Tables 3 and 4, respectively. All the four individuals harbouring major mutations presented with high viral load of 4624, 291,124, 141,341 and 209,871 copies/ml, which was greater than 1000 copies/ml viral load threshold required for viral suppression in the community PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/27488460 [42]. In addition, three of the individuals with major mutations presented with CD4+ T cell counts of 473, 39, and 162 cells/l which were <500 cells/l. Carriage of minor mutations was not associated with viral load in all the study groups (P > 0.05), but among ART-naive non-drug users, CD4+ T cell counts were significantly lower in carriers of minor mutations compared to non-carriers (median, 455; IQR , 599 vs. 989, 507; P = 0.005).Discussion Effective use of protease inhibitors in HIV-1 treatment and prevention is largely impeded by the increasing development and spread of acquired and transmitted resistance [43]. Antiretroviral treatment-naive and -experienced PubMed ID:http://www.ncbi.nlm.nih.gov/pubmed/27488460 IDUs are at an increased risk of acquiring antiretroviral drug resistance as a consequence of high risk sexual and injection practices [44]. In addition, increased selecti.