Epidemiology of Transmitted Drug Resistance in Chronically HIV-Infected Patients in Germany: The RESINA Study 2001–2009

Oette, Mark; Reuter, Stefan; Kaiser, Rolf; Lengauer, Thomas; Fätkenheuer, Gerd; Knechten, Heribert; Hower, Martin; Pfister, Herbert; Häussinger, Dieter

doi:10.1159/000332015

Cited by 20 publications

(22 citation statements)

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“…Patients are included in the RESINA cohort at the time of the intended start of ART. Since 2001, RESINA is an ongoing study analyzing epidemiological and immunological data, HIV resistance patterns and therapeutic data in treatment-naive HIV-positive patients – as also described by Oette et al [25]. …”

Section: Methodsmentioning

confidence: 99%

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

et al. 2012

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Background: Older HIV patients are defined as aged 50 years and older. This group is a growing population in developed countries. In order to improve care for older HIV patients, we intended to gain insight into the specific features of transmission, epidemiology, immunology and antiretroviral treatment (ART) of this population. Patients and Methods: All patients from the RESINA cohort were analyzed, comprising 2,085 individuals at the beginning of 2010. RESINA is an ongoing study analyzing epidemiological and immunological data, resistance patterns and therapeutic data in treatment-naive HIV-positive patients from North Rhine-Westphalia, Germany. Patients are included in the RESINA cohort at the time of the intended start of ART. For statistical evaluation, we used χ² and Mann-Whitney U tests. Results: A total of 14.6% of patients in our cohort was above 50 years. Men were significantly more prevalent among older patients (86.8 vs. 78.6%; p < 0.001). The proportion of older patients was significantly higher in the heterosexual group (30%) as compared to bisexual (20%), homosexual (13%) and intravenous drug user (4%) modes of transmission (p < 0.001). When comparing ethnic groups, older patients were most often found among Caucasians (17 vs. 4% in other groups, p < 0.001). No significant difference for transmitted drug resistance patterns was found. The proportion of older patients with CDC stage A was significantly lower than with stages B or C (10 vs. 21 vs. 21%, p < 0.001). In older patients, changes of ART regimes were more frequent (p = 0.015) and the median CD4 cell count at the start of treatment was lower (176 vs. 200/µl, p = 0.017). After 72 weeks of ART, the relative increase of CD4 cells was significantly lower in older as compared to younger patients (200 vs. 231/µl, p = 0.017). Conclusions: Our results provide insight into the epidemiology of HIV in the elderly. In our cohort, the typical older patient was a Caucasian male who had acquired HIV through heterosexual contact. The prognosis in older patients is worsened as a result of several unfavorable circumstances, such as delayed start of ART, more frequent treatment changes and diminished immune reconstitution. As a consequence, better strategies for more frequent HIV testing in patients at risk for HIV are needed, and ART should be offered to older patients at earlier time points and higher CD4 cell counts.

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Section: Methodsmentioning

confidence: 99%

Risk Factors Associated with Older Age in Treatment-Naive HIV-Positive Patients

et al. 2012

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“…The study reported an average DRM prevalence of 9.2% in 2001-2009 (NRTIs 5.8%, NNRTIs 2.7%, and PIs 2.7%) in North Rhine-Westphalia, Germany [13]. Moreover, subtype B was predominant (72%) and recombinant forms were found in only 6% of the therapy-naïve patients.…”

Section: Discussionmentioning

confidence: 99%

“…To date, it is the first study on HIV-1 subtype diversity and prevalence of DRMs in therapy-naïve HIV-1-infected children receiving routine care at a center in Germany. This cohort study reveals adifferent HIV-1 subtype distribution with predominant non-B subtype infections versus the therapy-naïve HIV-1-infected adults in the RESINA cohort in Germany [13]. This difference is mainly attributed to the different ethnic backgrounds with a higher proportion of immigrants from sub-Saharan Africa in the pediatric cohort.…”

Section: Discussionmentioning

confidence: 99%

“…The prevalence of transmitted DRMs in HIV-infected therapy-naïve adults in Germany was documented in the RESINA Study, and found to be 9.2% between 2001 and 2009 (nucleoside reverse-transcriptase inhibitors [NRTIs]) 5.8%, non-NRTIs [NNRTI] 2.7%, and protease inhibitors [PIs] 2.7%) [13]. There are no data on DRMs and HIV-1 subtypes of HIV-1-infected children living in Germany.…”

Section: Introductionmentioning

confidence: 99%

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HIV-1 Subtype Diversity and Prevalence of Primary Drug Resistance in a Single-Center Pediatric Cohort in Germany

Neubert

Michalsky²,

Laws³

et al. 2016

Intervirology

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Objectives: Data on drug-resistant mutations (DRMs) in HIV-1-infected therapy-naïve children are scarce. The aim of this study was to determine the HIV-1 subtype distribution and the prevalence of DRMs in therapy-naïve HIV-1-infected children who received routine care at the University Hospital Düsseldorf, Düsseldorf, Germany. Methods: Records of all HIV-1-infected children who received routine care between January 2005 and December 2015 were analyzed retrospectively. The collected data included demographics, clinical characteristics, CD4 cell count, viral load, HIV-1 subtype, and resistance genotype at baseline. Results: 83 HIV-1-infected children received routine care during the observation period. HIV-1 subtypes were available in 61/83 patients (73.5%) and baseline HIV-1 resistance in 24 (29%). The prevalence of major DRMs was 29% (21% nucleoside reverse-transcriptase inhibitors [NRTIs], 12.5% non-NRTIs, and 4% protease inhibitors). Minor mutations in the protease gene were common (58%). Non-B subtypes were predominant (77%). Conclusions: We report a predominance of non-subtype-B infections and a higher prevalence of DRMs compared to other pediatric cohorts from resource-rich settings. The difference in HIV-1 subtype distribution is due to the fact that a relevant proportion of pediatric patients in Germany are immigrants from high-prevalence settings in sub-Saharan Africa where non-B subtypes predominate.

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“…In general, it seems that the prevalence of transmitted HIV drug resistance (TDR) has followed a steady pattern in developed countries [49] , recently conducted surveys in western Europe and United States have shown that the trend of TDR has become stable in recent years [50,51] . Increasing efficacy of HAART and development of new generation ARV agents have been proposed as possible reasons for this trend [52][53][54][55] . In some previous studies in developed settings, HIV drug resistance was more common among men who have sex with men (MSM), as well as among individuals with a positive history of STIs, mono-therapy, and NNRTI use [30] .…”

Section: Prevalence and Spatial Distribution Of Ardrmentioning

confidence: 99%