Abstract
BackgroundIn Europe, a continuous programme (SPREAD) has been in place for ten years to study transmission of drug resistant HIV. We analysed time trends of transmitted drug resistance mutations (TDRM) in relation to the risk behaviour reported.MethodsHIV-1 patients newly diagnosed in 27 countries from 2002 through 2007 were included. Inclusion was representative for risk group and geographical distribution in the participating countries in Europe. Trends over time were calculated by logistic regression.ResultsFrom the 4317 patients included, the majority was men-having-sex-with-men -MSM (2084, 48%), followed by heterosexuals (1501, 35%) and injection drug users (IDU) (355, 8%). MSM were more often from Western Europe origin, infected with subtype B virus, and recently infected (<1 year) (p<0.001). The prevalence of TDRM was highest in MSM (prevalence of 11.1%), followed by heterosexuals (6.6%) and IDU (5.1%, p<0.001). TDRM was predominantly ascribed to nucleoside reverse transcriptase inhibitors (NRTI) with a prevalence of 6.6% in MSM, 3.3% in heterosexuals and 2.0% in IDU (p = 0.001). A significant increase in resistance to non- nucleoside reverse transcriptase inhibitors (NNRTIs) and a decrease in resistance to protease inhibitors was observed in MSM (p = 0.008 and p = 0.006, respectively), but not in heterosexual patients (p = 0.68 and p = 0.14, respectively).ConclusionsMSM showed to have significantly higher TDRM prevalence compared to heterosexuals and IDU. The increasing NNRTI resistance in MSM is likely to negatively influence the therapy response of first-line therapy, as most include NNRTI drugs.
Highlights
Antiretroviral therapy has strongly reduced morbidity and mortality in HIV infected individuals [1]
Within the heterosexuals and injection drug users (IDU) risk groups, a high ratio of patients had an unknown date of infection (85% and 73%, respectively)
For the non-nucleoside reverse transcriptase inhibitor (NNRTI) transmitted drug resistance mutations (TDRM), the prevalence in Men having sex with men (MSM) (3.8%; 95% confidence interval (CI): 3.1– 4.7%) was significantly higher compared to heterosexuals (1.9%; 95% CI: 1.3–2.7%; p,0.001) but not to IDU (2.8%; 95% CI: 2.3– 1.3%; p = 0.44)
Summary
Antiretroviral therapy has strongly reduced morbidity and mortality in HIV infected individuals [1]. Heterosexually infected patients in Europe are mostly immigrants from Sub-Saharan Africa or individuals from Eastern Europe areas where the use of antiretrovirals in this case in the form of combination antiretroviral therapy has been initiated more recently. These differences in treatment history between the risk groups are reflected in several studies showing a higher likelihood in MSM to be infected with resistant virus compared to other risk groups [3,11,12]. We analysed time trends of transmitted drug resistance mutations (TDRM) in relation to the risk behaviour reported
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