HIV Genotypes and Primary Drug Resistance Among HIV-Seropositive Blood Donors in Brazil: Role of Infected Blood Donors as Sentinel Populations for Molecular Surveillance of HIV

Alencar, Cecília S. MSc*,†; Sabino, Ester C. MD, PhD; Carvalho, Silvia M. F. PhD§; Leao, Silvana C. MD; Carneiro-Proietti, Anna B. MD, PhD; Capuani, Ligia BSc#; Oliveira, Cláudia L. MD, PhD**; Carrick, Danielle PhD, MHS††; Birch, Rebecca J. MPH††; Gonçalez, Thelma T. MD, PhD‡‡; Keating, Sheila PhD‡‡; Swanson, Priscilla A. MSc§§; Hackett, John Jr PhD§§; Busch, Michael P. MD, PhD‡‡; for the NHLBI Retrovirus Epidemiology Donor Study-II (REDS-II), International Component

JAIDS Journal of Acquired Immune Deficiency Syndromes:
doi: 10.1097/QAI.0b013e31828ff979
Epidemiology and Prevention

Background: There are few surveillance studies analyzing genotypes or primary (transmitted) drug resistance in HIV-infected blood donors in Brazil. The aim of this study was to characterize patterns of HIV genotypes and primary resistance among HIV-seropositive donors identified at 4 geographically dispersed blood centers in Brazil.

Methods: All HIV-infected donors who returned for counseling at the 4 REDS-II Hemocenters in Brazil from January 2007 to March 2011 were invited to participate in a case–control study involving a questionnaire on risk factors. Viral sequencing was also offered to positive cases to assign genotypes and to detect and characterize primary resistance to reverse transcriptase and protease inhibitors according to World Health Organization guidelines.

Results: Of the 341 HIV-seropositive donors who consented to participate in the risk factor and genetics study, pol sequences were obtained for 331 (97%). Clade B was predominant (76%) followed by F (15%) and C (5%). Primary resistance was present in 36 [12.2%, 95% confidence interval (CI) 8.2 to 15.5] of the 303 individuals not exposed to antiretroviral therapy, varying from 8.2% (95% CI: 2.7 to 13.6) in Recife to 19.4% in São Paulo (95% CI: 9.5 to 29.2); there were no significant correlations with other demographics or risk factors.

Conclusions: Although subtype B remains the most prevalent genotype in all 4 areas, increasing rates of subtype C in Sao Paulo and F in Recife were documented relative to earlier reports. Transmitted drug resistance was relatively frequent, particularly in the city of Sao Paulo which showed an increase compared with previous HIV-seropositive donor data from 10 years ago.

Author Information

*Department of Infectious Disease, Federal University of Sao Paulo, Sao Paulo, Brazil;

LIM03, Laboratório de Medicina Laboratorial/ Departamento de Patologia, Hospital das Clinicas FMUSP, Sao Paulo, Brazil;

Department of Infectious Disease/Institute of Tropical Medicine, University of São Paulo, Sao Paulo, Brazil;

§Hemorio, Rio de Janeiro, Brazil;

Hemope, Recife, Brazil;

Hemominas, Belo Horizonte, Brazil;

#Fundaçao Pro-Sangue/Hemocentro de Sao Paulo, Brazil;

**Federal University of Sao Joao del Rey, Divinopolis, Brazil;

††Westat, Rockville, MD;

‡‡Blood Systems Research Institute, San Francisco, CA;

§§Emerging Pathogens and Virus Discovery, Abbott Diagnostics, Abbott Park, IL.

Correspondence to: Ester C. Sabino, MD, PhD, Department of Infectious Disease/Institute of Tropical Medicine, University of Sao Paulo, Av. Dr Enéas Carvalho de Aguiar, 470, CEP 05403-000 São Paulo, Brazil (e-mail:

Supported by NIIH (HHSN268200417175C/HO/NHLBI NIH HHS).

The authors have no conflicts of interest to disclose.

The Retrovirus Epidemiology Donor Study-II, International Component (Brazil), is the responsibility of the following persons: Blood Centers—Fundação Pró-Sangue/Hemocentro São Paulo (São Paulo): E. C. S., Cesar de A-N, A. M. Jr, L. C., and N. A. S. Hemominas (Belo Horizonte, Minas Gerais): A. B., F. C-P, F. A. P., C. Di L. O., and C. M.; Fundação Hemope (Recife, Pernambuco): D. de A. S., S. A. C. L., and M. I. L.; and H. (Rio de Janeiro): C. L., M. E. L., and S. M. F. C. DataWarehouse—University of São Paulo (São Paulo): J. E. F., M. O., and P. L. T. US Investigators—Blood Systems Research Institute and University of California at San Francisco: M. P. B., E. L. M., B. C. and T. G. Coordinating Center—Westat, Inc: J. S., M. K. and K. K. National Heart, Lung, and Blood Institute, NIH: S. A. G.

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Received October 18, 2012

Accepted February 18, 2013

© 2013 Lippincott Williams & Wilkins, Inc.