The aim of this study was to determine the prevalence of transmitted drug resistance (TDR) in newly diagnosed
and treatment-naive HIV-infected patients from Croatia and evaluate a possible contribution of transmission
clusters to the spread of resistant virus. The study enrolled treatment-naive HIV-infected patients that entered
clinical care at the Croatian Reference Center for HIV/AIDS between 2006 and 2008. The protease gene and a
part of the reverse transcriptase gene of the HIV-1 genome were sequenced by using the Trugene HIV-1
Genotyping System. The prevalence of transmitted drug resistance was analyzed by using the surveillance drug
resistance mutations (SDRM) list recommended by the WHO in 2009. We report findings for 118 of 180 eligible
patients (65.6% coverage). SDRM were detected in 26 of 118 patients (22.0%) who were infected with subtype B
and belonged mostly to the men having sex with men (MSM). The majority of patients with primary resistance
carried SDRM associated with resistance to nucleoside analogues reverse transcriptase inhibitors (NRTIs, 23 of
118 patients, 19.5%). The most frequently found NRTI SDRM was T215S (17 of 118 patients, 14.4%). SDRM
associated with resistance to nonnucleoside reverse transcriptase inhibitors were detected in three (2.5%) patients
and primary resistance to protease inhibitors was not detected. Non-B subtypes were detected in 13/118
patients (11%). A total of 12 transmission pairs and eight distinct transmission clusters were identified with the
largest cluster harboring sequences from 19 patients; among them all but two were carrying the T215S mutation.
This study showed a high prevalence of TDR in newly diagnosed MSM from Croatia and is an important
contribution concerning the relationship between local transmission clusters and the spread of resistant virus.