Trends in Transmission of Drug Resistance and Prevalence of Non-B Subtypes in Patients with Acute or Recent HIV-1 Infection in Barcelona in the Last 16 Years (1997-2012).

Juan Ambrosioni,María Ángeles Marcos,Manuel Gómez-Carrillo,María López-Diéguez,Omar Sued,Fernando Agüero,Christian Manzardo,David Nicolas,Laura Zamora,Anabel Romero,Marta Parera,Tomás Pumarola,José María Miró,José María Gatell

doi:10.1371/journal.pone.0125837

Abstract

ObjectivesTo evaluate the prevalence of transmitted drug resistance (TDR) and non-B subtypes in patients with acute/recent HIV-1 infection in Barcelona during the period 1997-2012.MethodsPatients from the “Hospital Clínic Primary HIV-1 Infection Cohort” with a genotyping test performed within 180 days of infection were included. The 2009 WHO List of Mutations for Surveillance of Transmitted HIV-1 Drug Resistance was used for estimating the prevalence of TDR and phylogenetic analysis for subtype determination.Results189 patients with acute/recent HIV-1 infection were analyzed in 4 time periods (1997-2000, n=28; 2001-4, n=42; 2005-8, n=55 and 2009-12, n=64). The proportion of patients with acute/recent HIV-1 infection with respect to the total of newly HIV-diagnosed patients in our center increased over the time and was 2.18%, 3.82%, 4.15% and 4.55% for the 4 periods, respectively (p=0.005). The global prevalence of TDR was 9%, or 17.9%, 9.5%, 3.6% and 9.4% by study period (p=0.2). The increase in the last period was driven by protease-inhibitor and nucleoside-reverse-transcriptase-inhibitor resistance mutations while non-nucleoside-reverse-transcriptase inhibitor TDR and TDR of more than one family decreased. The overall prevalence of non-B subtypes was 11.1%, or 0%, 4.8%, 9.1% and 20.3 by study period (p=0.01). B/F recombinants, B/G recombinants and subtype F emerged in the last period. We also noticed an increase in the number of immigrant patients (p=0.052). The proportion of men-who-have-sex-with-men (MSM) among patients with acute/recent HIV-1 infection increased over the time (p=0.04).ConclusionsThe overall prevalence of TDR in patients with acute/recent HIV-1 infection in Barcelona was 9%, and it has stayed relatively stable in recent years. Non-B subtypes and immigrants proportions progressively increased.

Highlights

Antiretroviral therapy (ART) has dramatically changed the natural history of HIV infection
The proportion of patients with acute/recent HIV-1 infection with respect to the total of newly HIV-diagnosed patients in our center increased over the time and was 2.18%, 3.82%, 4.15% and 4.55% for the 4 periods, respectively (p=0.005)
The overall prevalence of transmitted drug resistance (TDR) in patients with acute/recent HIV-1 infection in Barcelona was 9%, and it has stayed relatively stable in recent years

Summary

Introduction

Antiretroviral therapy (ART) has dramatically changed the natural history of HIV infection. During treatment, almost one-quarter of patients experience virological failure and often have resistant HIV isolates [1]. The widespread use of ART and the increased survival of patients receiving it make the transmission of resistant HIV strains likely to occur. Active surveillance of TDR provides important information about the factors involved in the transmission of resistant HIV strains and in the selection of ART components. It plays a major role in the design of strategies to control the evolution and emergence of resistance [4]

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