JAC Advance Access originally published online on July 16, 2009
Journal of Antimicrobial Chemotherapy 2009 64(3):607-615; doi:10.1093/jac/dkp246
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Original research |
Prevalence of transmitted HIV-1 drug resistance in HIV-1-infected patients in Italy: evolution over 12 years and predictors
1 Institute of Clinic of Infectious Diseases, Catholic University of Sacred Heart, Rome, Italy 2 Institute of Virology, University of Siena, Italy 3 Clinic of Infectious Diseases, Careggi Hospital, Florence, Italy 4 Second Department of Infectious disease, L. Sacco Hospital, Milan, Italy 5 Microbiology Laboratory, L. Sacco Hospital, Milan, Italy 6 Infectious Diseases Dept, Foundation ‘IRCCS San Matteo Hospital’, Pavia, Italy 7 Clinic of Infectious Diseases, S. Raffaele Hospital, Milan, Italy 8 Clinic of Infectious Diseases, Galliera Hospitals, Genoa, Italy 9 Clinic of Internal Medicine and Clinical Immunology, University of Genoa, Genoa, Italy 10 Unit of Clinical Immunology, Ospedali Riuniti di Ancona, Ancona, Italy 11 Infectious Diseases, Pistoia Hospital, Pistoia, Italy 12 Infectious Diseases, Grosseto Hospital, Grosseto, Italy
Received 31 March 2009; returned 11 May 2009; revised 16 June 2009; accepted 21 June 2009
* Corresponding author. Istituto di Clinica delle Malattie Infettive, Università Cattolica del S. Cuore, Largo Francesco Vito 1, 00168 Roma, Italy. Tel: +39-06-3015-4945; Fax: +39-06-3054-519; E-mail: laura.bracciale{at}poste.it
Objectives: Transmitted HIV-1 drug resistance (TDR) can reduce the efficacy of first-line antiretroviral therapy.
Patients and methods: A retrospective analysis was performed to assess the prevalence and correlates of TDR in Italy over time. TDR was defined as the presence of at least one of the mutations present in the surveillance drug resistance mutation (SDRM) list.
Results: Among 1690 antiretroviral therapy-naive patients, the most frequent HIV subtypes were B (78.8%), CRF02_AG (5.6%) and C (3.6%). Overall, TDR was 15%. TDR was 17.3% in subtype B and 7.0% in non-B carriers (P < 0.001). TDR showed a slight, although not significant, decline (from 16.3% in 1996–2001 to 13.4% in 2006–07, P = 0.15); TDR declined for nucleoside reverse transcriptase inhibitors (from 13.1% to 8.2%, P = 0.003) but remained stable for protease inhibitors (from 3.7% to 2.5%, P = 0.12) and non-nucleoside reverse transcriptase inhibitors (from 3.7% to 5.8%). TDR to any drug was stable in B subtype and showed a decline trend in non-B. In multivariable analysis, F1 subtype or any non-B subtype, compared with B subtype, and higher HIV RNA were independent predictors of reduced odds of TDR.
Conclusions: 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.
Keywords: drug-naive , subtype , decline