Prevalence of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy: evolution over 12 years and predictors

Bracciale, Laura; Colafigli, Manuela; Zazzi, Maurizio; Corsi, Paola; Meraviglia, Paola; Micheli, Valeria; Maserati, Renato; Gianotti, Nicola; Penco, Giovanni; Setti, Maurizio; Giambenedetto, Simona Di; Butini, Luca; Vivarelli, Angela; Trezzi, Michele; Luca, Andrea De

doi:10.1093/jac/dkp246

Cited by 30 publications

(33 citation statements)

References 29 publications

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“…This number corresponds with a number of other surveys in Europe [3,5,6,9,11,12,23], but several studies from Europe [4,8,24] and Northern America [7,10,25] report different frequencies. The majority of mutations were found in the substance class of NRTI.…”

Section: Discussionsupporting

confidence: 86%

“…Drug resistance in these patients, though never exposed to antiretroviral drugs, is defined as primary or transmitted resistance. This phenomenon has been addressed in a number of studies in recent years [2,3,4,5,6,7,8,9,10,11]. Different analyses showed reduced efficacy of ART in cases with primary drug resistance in bulk sequencing or as a minority strain [12,13,14,15,16,17,18].…”

Section: Introductionmentioning

confidence: 99%

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

Oette

Reuter²,

Kaiser³

et al. 2012

Intervirology

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Objectives: Transmitted HIV drug resistance may impair treatment efficacy of combination antiretroviral therapy (ART). This study describes the epidemiology of transmitted resistance in chronically infected patients. Methods: In a prospective multicenter trial in Nordrhein-Westfalen, Germany, transmitted drug resistance was determined by genotypic resistance testing in patients on initiation of first-line ART. Results: From 2001 to 2009, 2,078 patients were enrolled in the study. 79.9% were male, 81.2% were Caucasians, and a homosexual transmission mode was found in 51.3%. Of these patients, 41.5% were at the stage of AIDS, median CD4 cell count was 230/µl, and median viral load was 64.466 copies/ml. Transmitted drug resistance mutations were seen in 9.2% (95% CI, 7.9–10.4). Resistance in the nucleoside reverse transcriptase inhibitor class was found in 5.8% (4.8–6.8), in the nonnucleoside reverse transcriptase inhibitor class in 2.8% (2.1–3.6), and in the protease inhibitor class in 2.7% (2.0–3.4). After a continuous increase to a level above 10% in the years 2006 and 2007, a decline of drug resistance prevalence followed in 2008 and 2009. Conclusions: Transmitted HIV drug resistance was found in around 10% of chronically infected patients in Germany who started their ART. We showed a moderate decline of the prevalence of mutant virus strains in recent years. Further surveillance of this phenomenon is mandatory.

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Section: Discussionsupporting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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

Oette

Reuter²,

Kaiser³

et al. 2012

Intervirology

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“…Moreover, our results are in agreement with recent reports on TDR from several European cohorts. 11,25,26,6,27,28 Several reports indicate that the number of new diagnoses of HIV infection is either stable or increasing in some developed countries with a rising incidence in MSM. 1,2 This epidemic among MSM continues despite the widespread availability of effective antiretroviral therapy and requires specific interventions.…”

Section: Discussionmentioning

confidence: 99%

Transmission of Resistant HIV Type 1 Variants and Epidemiological Chains in Italian Newly Diagnosed Individuals

Lai

Violin

Ebranati

et al. 2012

AIDS Research and Human Retroviruses

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Transmission of HIV-1 and drug resistance continue to occur at a considerable level in Italy, influenced mainly by changes in modality of infection. However, the long period of infectivity makes difficult the interpretation of epidemiological networks, based on epidemiological data only. We studied 510 naive HIV-1-infected individuals, of whom 400 (78.4%) were newly diagnosed patients with an unknown duration of infection (NDs), with the aim of identifying sexual epidemiological networks and transmitted drug resistance (TDR) over a 7-year period. Clusters were identified by Bayesian methods for 412 patients with B subtype; 145 individuals (35.2%) clustered in 34 distinct clades. Within epidemiological networks males were 93.1% (n = 135); the same proportion of patients has been infected by the sexual route; 62.1% (n = 90) were men having sex with men (MSM) of whom 67.8% (n = 61) were NDs. Among heterosexuals (n = 44), males were predominant (79.5%, n = 35) and 77.3% (n = 34) were NDs. TDR in clusters was 11.7 % (n = 17), of whom 76.5% (n = 13) was found in MSM. TDR was predominantly associated with NRTI resistance in individuals with chronic infection (n = 11). A high prevalence of epidemiological networks has been found in the metropolitan area of Milan, indicating a high frequency of transmission events. The cluster analysis of networks suggested that the source of new infections was mainly represented by males and MSM who have long lasting HIV-1 infection. Notably, the prevalence of resistanceconferring mutations was higher in chronically infected patients, carrying mainly resistance to thymidine analogs, the backbone of first antiretroviral (ARV) generation. Intervention strategies of public health are needed to limit HIV-1 transmission and the associated TDR.

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“…12 Bracciale et al demonstrated that the transmission of nucleoside reverse transcriptase inhibitor (NRTI) and protease inhibitor (PI) resistance declined over time, but nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance increased from 3.7% during 1996-2001 to 7.8% during 2002-2004 and remained stable thereafter (5.8% in 2006-2007). 13 Previous data highlight that the presence of TDRM influences the outcome of initial cART and pre-cART genotype resistance testing improves clinical outcomes and is cost effective.…”

Section: Introductionmentioning

confidence: 99%

Transmitted Drug-Resistant HIV Type 1 Remains Prevalent and Impacts Virologic Outcomes Despite Genotype-Guided Antiretroviral Therapy

Taniguchi

Nurutdinova²,

Grubb³

et al. 2012

AIDS Research and Human Retroviruses

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Trends in transmitted drug resistance-associated mutations (TDRM) in HIV-1infection vary depending on geographic and cohort characteristics. The impact of TDRM among patients receiving fully active combination antiretroviral therapy (cART) is poorly characterized. This was a retrospective study of 801 HIV-1-infected treatment-naive patients from 2001 to 2009 who had pre-cART genotype resistance test results available. The prevalence of TDRM was compared for each year strata. Multivariate Cox proportional hazards regression models were used to assess factors associated with virologic failure at 48 weeks. TDRM was detected in 136 (17%) patients with ‡ 2 class TDRM in 20 patients. K103N/S was the most frequent (n = 77). There were no changes in the prevalence of mutations over time (P trend = 0.67). Six hundred and eleven patients were started on cART. Virologic failure occurred in 38% of those with TDRM and 24% of those without ( p < 0.01). In multivariate analysis, nonnucleoside reverse transcriptase inhibitor (NNRTI) resistance was associated with a 1.5-fold increased risk of virologic failure. TDRM remains common among treatment-naive HIV-1-infected patients, affecting one in six patients. Transmission of NNRTI drug resistance was associated with risk of virologic failure despite initiation of genotype-guided cART.

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Prevalence of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy: evolution over 12 years and predictors

Abstract: Prevalence of TDR to nucleoside reverse transcriptase inhibitors seems to have declined in Italy over time. Increased prevalence of non-B subtypes partially justifies this phenomenon.

Cited by 30 publications

References 29 publications

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

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

Transmission of Resistant HIV Type 1 Variants and Epidemiological Chains in Italian Newly Diagnosed Individuals

Transmitted Drug-Resistant HIV Type 1 Remains Prevalent and Impacts Virologic Outcomes Despite Genotype-Guided Antiretroviral Therapy

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