Improved Virological Outcomes in British Columbia Concomitant with Decreasing Incidence of HIV Type 1 Drug Resistance Detection

Abstract

Background There have been limited studies evaluating temporal changes in the incidence of detection of drug resistance among human immunodeficiency virus type 1 (HIV-1) isolates and concomitant changes in plasma HIV load for treated individuals in a population-wide setting. Methods Longitudinal plasma viral load and genotypic resistance data were obtained from patients receiving antiretroviral therapy from the British Columbia Drug Treatment Program from July 1996 through December 2008. A total of 24,652 resistance tests were available from 5422 individuals. The incidence of successful plasma viral load suppression and of resistance to each of 3 antiretroviral categories (nucleoside/nucleotide reverse-transcriptase inhibitors, nonnucleoside reverse transcriptase inhibitors, and protease inhibitors) was calculated for the population receiving therapy. Results There has been a drastic decrease in the incidence of new cases of HIV-1 drug resistance in individuals followed during 1996–2008. In 1997, the incidence rate of any newly detected resistance was 1.73 cases per 100 person-months of therapy, and by 2008, the incidence rate had decreased >12-fold, to 0.13 cases per 100 person-months of therapy. This decrease in the incidence of resistance has occurred at an exponential rate, with half-times on the order of 2–3 years. Concomitantly, the proportion of individuals with plasma viral load suppression has increased linearly over time (from 64.7% with HIV RNA levels <50 copies/mL in 2000 to 87.0% in 2008; R2 = 0.97; P <.001). Conclusions Our results suggest an increasing effectiveness of highly active antiretroviral therapy at the populational level. The vast majority of treated patients in British Columbia now have either suppressed plasma viral load or drug-susceptible HIV-1, according to their most recent test results.

The Adolescent and Young Adult HIV Cascade of Care in the United States: Exaggerated Health Disparities

“…Although recent studies with newer ART regimens have suggested high levels of viral suppression in adults, 5,6 adolescents and young adults do not appear to achieve this goal. Recent first-line viral suppression rates after Highly Active Antiretroviral Therapy (HAART) initiation for adolescents in clinical trials report suppression rates as high as 86%.…”

“…[1][2][3] Simpler, more potent, and less toxic regimens have achieved high levels of sustained HIV viral suppression in clinical trials 4 and in clinical practice. 5,6 A large, multinational, randomized controlled trial has demonstrated the efficacy of how early initiation of antiretroviral treatment can decrease HIV transmission. 1 However, several distinct American populations are not yet benefiting from the movement towards earlier ART initiation.…”

HIV Drug Resistance Testing by High-Multiplex “Wide” Sequencing on the MiSeq Instrument

“…These challenges are particularly acute in low-and middle-income countries (LMIC), where access to drug resistance testing is problematic due to limited resources and infrastructure. Currently, the majority of incident cases of clinically relevant HIV drug resistance involve nonnucleotide reverse transcriptase inhibitor (NNRTI) resistance; therefore, novel resistance testing methods for use in LMIC should, at a minimum, target the HIV reverse transcriptase (RT) region (10)(11)(12)(13).…”

Assessing Risk for Cardiovascular Disease in Patients With Human Immunodeficiency Virus

“…Furthermore, these complications seem to be occurring at higher rates than in age-matched control individuals, likely accounting for the fact that survival of HIV patients still does not match that in the uninfected population, 1 even though viral replication can be controlled in the vast majority of patients in care. 5 In addition, clinical observations from clinicians and patients, some of which have prominently appeared in the lay press, 6,7 cite a process of accelerated aging and debility among those with HIV despite effective treatment.…”