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ObjectiveTo describe and analyze transmitted drug resistance (TDR) between 2014 and 2019 in newly infected patients with HIV-1 in Portugal and to characterize its transmission networks.MethodsClinical, socioepidemiological, and risk behavior data were collected from 820 newly diagnosed patients in Portugal between September 2014 and December 2019. The sequences obtained from drug resistance testing were used for subtyping, TDR determination, and transmission cluster (TC) analyses.ResultsIn Portugal, the overall prevalence of TDR between 2014 and 2019 was 11.0%. TDR presented a decreasing trend from 16.7% in 2014 to 9.2% in 2016 (pfor–trend = 0.114). Multivariate analysis indicated that TDR was significantly associated with transmission route (MSM presented a lower probability of presenting TDR when compared to heterosexual contact) and with subtype (subtype C presented significantly more TDR when compared to subtype B). TC analysis corroborated that the heterosexual risk group presented a higher proportion of TDR in TCs when compared to MSMs. Among subtype A1, TDR reached 16.6% in heterosexuals, followed by 14.2% in patients infected with subtype B and 9.4% in patients infected with subtype G.ConclusionOur molecular epidemiology approach indicates that the HIV-1 epidemic in Portugal is changing among risk group populations, with heterosexuals showing increasing levels of HIV-1 transmission and TDR. Prevention measures for this subpopulation should be reinforced.

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Received 14 June 2012; returned 23 July 2012; revised 4 August 2012; accepted 13 August 2012Objectives: To investigate mutations selected in viruses from HIV-2-infected patients failing a highly active anti-retroviral treatment (HAART) regimen including atazanavir/ritonavir.Methods: Twenty-eight HIV-2-infected patients previously exposed to atazanavir/ritonavir and failing therapywere studied. The protease (PR) gene was amplified and sequenced, and mutations emerging under atazana-vir/ritonavir selective pressure were reported.Results: The I50L mutation emerged in 4 out of 28 HIV-2-infected patients failing a HAART regimen includingatazanavir/ritonavir. Besides I50L, four PR mutations previously associated with protease inhibitor resistance(I54L, I64V, V71I and I82F) and six PR mutations of unknown impact (V10I, E37D, S43T, K45R, I75V andF85L) in HIV-2 were also identified in this small group of patients.Conclusions: Severalmutationswereassociatedwithvirologicalfailureofaregimenincludingatazanavir/ritonavirinHIV-2-infectedpatients,includingI50Lforthefirsttime.ItshouldbeincludedinHIV-2algorithmsforinterpretationofgenotypic resistance data, and taken into account when making therapeutic decisions for HIV-2-infected patients.Keywords: protease, resistance, HIV-2

Introduction Portugal is the European country with the highest frequency of HIV-2 infection, which is mainly concentrated in West Africa. The cumulative number of notified HIV-2 infections in Portugal was 1813 by the end of December 2008. To better characterize the dynamics of HIV-2 infection in the country and to obtain data that may be of use in the prevention of the spread of HIV-2, we evaluated a large pooled sample of patients. Patients and methods Five Portuguese hospitals provided data on HIV-2-infected patients from 1984 to the end of 2007. Data concerning demographic characteristics and clinical variables were extracted. Patients were stratified according to date of diagnosis in approximately 5-year categories. Results The sample included 442 patients, accounting for 37% of all HIV-2 infections notified in Portugal during that period. HIV-2-infected patients showed clearly different characteristics according to the period of diagnosis. Until 2000, the majority of HIV-2-infected patients were Portuguese-born males living in the north of the country. From 2000 to 2007, most of the patients diagnosed with HIV-2 infection had a West African origin, were predominantly female and were living in the capital, Lisbon. The average age at diagnosis and loss to follow-up significantly increased over time. Conclusion HIV-2 infection has been documented in Portugal since the early 1980s and its epidemiology appears to reflect changes in population movement. These include the movements of soldiers and repatriates from African territories during the independence wars and, later, migration and mobility from high-endemicity areas. The findings of this study stress the importance of promoting migrant-sensitive health care.