Increasing Prevalence of HIV-1 Transmitted Drug Resistance in Portugal: Implications for First Line Treatment Recommendations
Open Access
- 30 October 2020
- Vol. 12 (11), 1238
- https://doi.org/10.3390/v12111238
Abstract
Introduction: Treatment for All recommendations have allowed access to antiretroviral (ARV) treatment for an increasing number of patients. This minimizes the transmission of infection but can potentiate the risk of transmitted (TDR) and acquired drug resistance (ADR). Objective: To study the trends of TDR and ADR in patients followed up in Portuguese hospitals between 2001 and 2017. Methods: In total, 11,911 patients of the Portuguese REGA database were included. TDR was defined as the presence of one or more surveillance drug resistance mutation according to the WHO surveillance list. Genotypic resistance to ARV was evaluated with Stanford HIVdb v7.0. Patterns of TDR, ADR and the prevalence of mutations over time were analyzed using logistic regression. Results and Discussion: The prevalence of TDR increased from 7.9% in 2003 to 13.1% in 2017 (p < 0.001). This was due to a significant increase in both resistance to nucleotide reverse transcriptase inhibitors (NRTIs) and non-nucleotide reverse transcriptase inhibitors (NNRTIs), from 5.6% to 6.7% (p = 0.002) and 2.9% to 8.9% (p < 0.001), respectively. TDR was associated with infection with subtype B, and with lower viral load levels (p < 0.05). The prevalence of ADR declined from 86.6% in 2001 to 51.0% in 2017 (p < 0.001), caused by decreasing drug resistance to all antiretroviral (ARV) classes (p < 0.001). Conclusions: While ADR has been decreasing since 2001, TDR has been increasing, reaching a value of 13.1% by the end of 2017. It is urgently necessary to develop public health programs to monitor the levels and patterns of TDR in newly diagnosed patients.Keywords
This publication has 39 references indexed in Scilit:
- RegaDB: community-driven data management and analysis for infectious diseasesBioinformatics, 2013
- Prevention of HIV-1 Infection with Early Antiretroviral TherapyNew England Journal of Medicine, 2011
- Replicative Fitness Costs of Nonnucleoside Reverse Transcriptase Inhibitor Drug Resistance Mutations on HIV Subtype CAntimicrobial Agents and Chemotherapy, 2011
- Increasing prevalence of transmitted drug resistance mutations and non-B subtype circulation in antiretroviral-naive chronically HIV-infected patients from 2001 to 2006/2007 in FranceJournal of Antimicrobial Chemotherapy, 2010
- Transmitted HIV Type 1 Drug Resistance and Non-B Subtypes Prevalence among Seroconverters and Newly Diagnosed Patients from 1992 to 2005 in ItalyAIDS Research and Human Retroviruses, 2010
- Prevalence of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy: evolution over 12 years and predictorsJournal of Antimicrobial Chemotherapy, 2009
- Drug Resistance Mutations for Surveillance of Transmitted HIV-1 Drug-Resistance: 2009 UpdatePLOS ONE, 2009
- Changing Rates and Patterns of Drug Resistance Mutations in Antiretroviral-Experienced HIV-Infected PatientsAIDS Research and Human Retroviruses, 2007
- The Fitness Cost of Mutations Associated with Human Immunodeficiency Virus Type 1 Drug Resistance Is Modulated by Mutational InteractionsJournal of Virology, 2007
- HIV Drug ResistanceNew England Journal of Medicine, 2004