{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T14:18:32Z","timestamp":1753885112051,"version":"3.41.2"},"reference-count":57,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T00:00:00Z","timestamp":1623196800000},"content-version":"vor","delay-in-days":159,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Coordination for the Improvement of Higher Education Personnel Coordena\u00e7\u00e3o de Aperfei\u00e7oamento de Pessoal de N\u00edvel Superior"},{"name":"Oswaldo Cruz Institute, FIOCRUZ, Rio de Janeiro, Rio de Janeiro, Brazil"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["BioMed Research International"],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:p>Virologic failure may occur because of poor treatment adherence and\/or viral drug resistance mutations (DRM). In Brazil, the northern region exhibits the worst epidemiological scenarios for the human immunodeficiency virus (HIV). Thus, this study is aimed at investigating the genetic diversity of HIV\u20101 and DRM in Manaus. The cross\u2010sectional study included people living with HIV on combined antiretroviral therapy and who had experienced virological failure during 2018\u20102019. Sequencing of the protease\/reverse transcriptase (PR\/RT) and C2V3 of the viral envelope gp120 (<jats:italic>Env<\/jats:italic>) regions was analyzed to determine subtypes\/variants of HIV\u20101, DRMs, and tropism. Ninety\u2010two individuals were analyzed in the study. Approximately 72% of them were male and 74% self\u2010declared as heterosexual. Phylogenetic inference (PR\/RT\u2010<jats:italic>Env<\/jats:italic>) showed that most sequences were <jats:italic>B<\/jats:italic> subtype, followed by BF1 or <jats:italic>B<\/jats:italic><jats:italic>C<\/jats:italic> mosaic genomes and few F1 and <jats:italic>C<\/jats:italic> sequences. Among the variants of subtype <jats:italic>B<\/jats:italic> at PR\/RT, 84.3% were pandemic (<jats:italic>B<\/jats:italic><jats:sub>PAN<\/jats:sub>), and 15.7% were Caribbean (<jats:italic>B<\/jats:italic><jats:sub>CAR<\/jats:sub>). The DRMs most frequent were M184I\/V (82.9%) for nucleoside reverse transcriptase inhibitors (NRTI), K103N\/S (63.4%) for nonnucleoside reverse transcriptase inhibitor (NNRTI), and V82A\/L\/M (7.3%) for protease inhibitors (PI). DRM analysis depicted high levels of resistance for lamivudine and efavirenz in over 82.9% of individuals; although, low (7.7%) cross\u2010resistance to etravirine was observed. A low level of resistance to protease inhibitors was found and included patients that take atazanavir\/ritonavir (16.6%) and lopinavir (11.1%), which confirms that these antiretrovirals can be used\u2014for most individuals. The thymidine analog mutations\u20102 (TAM\u20102) resistance pathway was higher in <jats:italic>B<\/jats:italic><jats:sub>CAR<\/jats:sub> than in <jats:italic>B<\/jats:italic><jats:sub>PAN<\/jats:sub>. Similar results from other Brazilian studies regarding HIV drug resistance were observed; however, we underscore a need for additional studies regarding subtype <jats:italic>B<\/jats:italic><jats:sub>CAR<\/jats:sub> variants. Molecular epidemiology studies are an important tool for monitoring the prevalence of HIV drug resistance and can influence the public health policies.<\/jats:p>","DOI":"10.1155\/2021\/5567332","type":"journal-article","created":{"date-parts":[[2021,6,9]],"date-time":"2021-06-09T17:54:25Z","timestamp":1623261265000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["High Detection Rate of HIV Drug Resistance Mutations among Patients Who Fail Combined Antiretroviral Therapy in Manaus, Brazil"],"prefix":"10.1155","volume":"2021","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3940-4227","authenticated-orcid":false,"given":"Yury Oliveira","family":"Chaves","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5826-6528","authenticated-orcid":false,"given":"Fl\u00e1vio Ribeiro","family":"Pereira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6892-538X","authenticated-orcid":false,"given":"Rebeca","family":"de Souza Pinheiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0324-2876","authenticated-orcid":false,"given":"Diego Rafael Lima","family":"Batista","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0358-3371","authenticated-orcid":false,"given":"Ant\u00f4nio Alcirley","family":"da Silva Balieiro","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3374-9985","authenticated-orcid":false,"given":"Marcus Vinicius Guimar\u00e3es","family":"de Lacerda","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9677-7225","authenticated-orcid":false,"given":"Paulo Afonso","family":"Nogueira","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8442-3427","authenticated-orcid":false,"given":"Monick Lindenmeyer","family":"Guimar\u00e3es","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2021,6,9]]},"reference":[{"key":"e_1_2_10_1_2","unstructured":"BrasilA. 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