INSPIRE

Description

HIV-1 non-B subtypes and recombinant variants, which are responsible for 90% of the 35 million infections worldwide, have a high genetic variability compared to subtype B isolates, and this high genetic diversity may influence the resistance pathways to current and newer antiretroviral (ARV) drugs. Naturally occurring polymorphisms affect ARV response in subtype B viruses. The impact of these polymorphisms on drug resistance and treatment success within the context of non-B HIV-1 strains is not well understood. Two-thirds of 2^nd line treatment failures among Nigerian patients with very good pharmacy record-derived adherence confirmed by plasma drug levels had emergent mutations in the HIV-1 gag gene. The purpose of this study is to evaluate HIV-1 drug resistance outside the classical targets (i.e., pol gene). The mutations identified in Env confer broad resistance to multiple classes of ARVs.  This study seeks to determine the virological basis for treatment failure in patients where resistance is not predicted by standard genotypic tests and correlate HIV resistance genotypes, phenotypes and clinical outcomes in patients infected with non-B HIV-1 subtypes.