JAC Advance Access published online on June 13, 2008
Journal of Antimicrobial Chemotherapy, doi:10.1093/jac/dkn228
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Original research |
Low prevalence of transmitted antiretroviral drug resistance in a large UK HIV-1 cohort
1 Department of Infection and Travel Medicine, James Cook University Hospital, Middlesbrough, UK 2 Department of Infectious Diseases and Sexual Health, Bradford Teaching Hospitals Foundation Trust, Bradford, UK 3 Department of Infection and Tropical Medicine, Newcastle General Hospital, Newcastle-upon-Tyne, UK 4 Department of Genitourinary Medicine, Royal Hallamshire Hospital, Sheffield, UK 5 South Yorkshire Regional Department of Infection and Tropical Medicine, Royal Hallamshire Hospital, Sheffield, UK 6 Department of Infection and Travel Medicine, St James’ Hospital, Leeds, UK 7 Department of Genitourinary Medicine, Newcastle General Hospital, Newcastle-upon-Tyne, UK 8 Department of Infection and Tropical Medicine, Castle Hill Hospital, Cottingham, East Yorkshire, UK
Received 30 December 2007; returned 27 March 2008; revised 8 May 2008; accepted 19 May 2008
* Corresponding author: Tel: +44-1642-850850; Fax: +44-1642-854017; E-mail: davidr.chadwick{at}stees.nhs.uk
Objectives: To describe current practice in testing for transmitted antiretroviral drug resistance (TDR) and the prevalence of TDR in a large UK HIV-1 cohort.
Methods: The study includes a retrospective analysis of newly diagnosed HIV-1-infected patients presenting to eight HIV clinics in the north of England between March 2005 and March 2007. Resistance mutations were defined by IAS-USA. Predicted phenotypes were calculated by the Stanford University database.
Results: Five hundred and fifty-eight patients were studied, of whom 394 (70.6%) had heterosexually acquired HIV and 377 (67.6%) were infected outside the UK. TDR testing was performed in 406 patients (72.8%). Thirteen of 392 viral resistance profiles (3.3%) showed genotypic TDR. There was no significant association between TDR and any demographic or risk factor or baseline CD4 count. In particular, rates of TDR were similar in white British (6/147, 4.1%) and black African (7/224, 3.1%) patients. The numbers of patients with TDR to individual drug classes were: nucleoside reverse transcriptase inhibitors, 2 (0.5%); non-nucleoside reverse transcriptase inhibitors, 7 (1.8%); and protease inhibitors, 4 (1.0%). No patients had multi-class resistance detected. Eleven patients (2.8%) were predicted to have significant phenotypic resistance to at least one drug.
Conclusions: In a large unselected UK cohort, with high coverage of TDR testing, the prevalence of TDR was low and is in accordance with recent data, showing a decrease in the prevalence of TDR in the UK. Differences in population mix did not appear to explain this low rate.
Key Words: HIV drug resistance/resistance mutations , antiretroviral therapy , knowledge/attitude/practice studies