Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe
2016
Background. Numerous studies have shown that baseline
drug resistancepatterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend
drug resistancetesting to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted
drug resistance(TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001. Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of
drug resistancemutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0. Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%-9.5%) in 2008-2010. The most frequent indicators of TDR were
nucleoside reverse transcriptase inhibitor(NRTI) mutations (4.5%), followed by nonnucleoside
reverse transcriptase inhibitor(NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of
patient isolateswere predicted to have resistance to regimens containing
efavirenzor
rilpivirine, respectively, independent of current NRTI backbones. Conclusions. Although TDR was highest for NRTIs, the impact of baseline
drug resistancepatterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different
drug classesis affected.
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