Abstract
ObjectivesTransmission of drug‐resistant HIV‐1 has decreased in the UK since the early 2000s. This analysis reports recent trends and characteristics of transmitted drug resistance (TDR) in the UK from 2010 to 2013.MethodsResistance tests conducted in antiretroviral treatment (ART)‐naïve individuals between 2010 and 2013 were analysed for the presence of transmitted drug resistance mutations (TDRMs), defined as any mutations from a modified 2009 World Health Organization surveillance list, or a modified 2013 International Antiviral Society‐USA list for integrase tests. Logistic regression was used to examine associations between demographics and the prevalence of TDRMs.Results TDRMs were observed in 1223 (7.5%) of 16 425 individuals; prevalence declined from 8.1% in 2010 to 6.6% in 2013 (P = 0.02). The prevalence of TDRMs was higher among men who have sex with men (MSM) compared with heterosexual men and women (8.7% versus 6.4%, respectively) with a trend for decreasing TDRMs among MSM (P = 0.008) driven by a reduction in nucleoside reverse transcriptase inhibitor (NRTI)‐related mutations. The most frequently detected TDRMs were K103N (2.2%), T215 revertants (1.6%), M41L (0.9%) and L90M (0.7%). Predicted phenotypic resistance to first‐line ART was highest to the nonnucleoside reverse transcriptase inhibitors (NNRTIs) rilpivirine and efavirenz (6.2% and 3.4%, respectively) but minimal to NRTIs, including tenofovir, and protease inhibitors (PIs). No major integrase TDRMs were detected among 101 individuals tested while ART‐naïve.ConclusionsWe observed a decrease in TDRMs in recent years. However, this was confined to the MSM population and rates remained stable in those with heterosexually acquired HIV infection. Resistance to currently recommended first‐line ART, including integrase inhibitors, remained reassuringly low.
Highlights
The majority of individuals initiating combination antiretroviral treatment (ART) suppress virus replication and are less likely to acquire drug resistance compared with individuals who were exposed to older ART regimens
Resistance data are linked to demographic and clinical patient data held in the UK Collaborative HIV Cohort study (UK CHIC) database [17] and the national HIV/AIDS Reporting System (HARS) database held at Public Heath England (PHE) [18]
A total of 40 549 individuals were tested for transmitted drug resistance mutations’ (TDRMs) while ART-na€ıve between 2005 and 2013 (Table 1)
Summary
The majority of individuals initiating combination antiretroviral treatment (ART) suppress virus replication and are less likely to acquire drug resistance compared with individuals who were exposed to older ART regimens. Onward transmission of drug-resistant HIV can have an adverse effect on the success of first-line treatment and may negatively impact an individual’s prognosis [2]. National guidelines in the UK [3] and many other European countries [4] recommend that newly diagnosed individuals have a resistance test to detect transmitted drug resistance (TDR) and help selection of a fully active first-line treatment regimen. The prevalence of TDR in individuals with a subtype B infection increased slightly between 2007 and 2009, driven by an increase in resistance to the nucleoside reverse transcriptase inhibitor (NRTI) drug class, leading to the hypothesis that onward transmission of persistent thymidine analogue mutations (TAMs) among undiagnosed men who have sex with men (MSM) may keep levels of TDR stable in this population [6]
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