Résumé
Objectives: We aim to identify long-term trends in HIV drug resistance before and after combined antiretroviral therapy (cART) initiation. Methods: IAS-USA (2015) mutations were identified in 23 271 HIV protease-reverse transcriptase sequences from 6543 treatment naïve adults in British Columbia. Participants who started cART between 1996 and 2014 were followed until April 2016. Equality of proportions test was used to compare the percentage of participants with acquired drug resistance (ADR) or transmitted drug resistance (TDR) in 1996, to those in 2014. Kaplan-Meier was used to estimate time to ADR in four drug resistance categories. Multivariable regression odds ratios (OR) of ADR for select clinical variables were determined by 5-year eras of cART initiation. Results: The proportion of individuals with ADR declined from 39% (51/132) to 3% (8/322) in 1996–2014 (p <0.0001), while the proportion with TDR increased from 12% (16/132) to 18% (59/322) (p 0.14). The estimated proportions of individuals with ADR rose to 29% (NNRTI), 28% (3TC/FTC), 14% (other nRTI), and 7% (PI) after >16 years of therapy. After 5 years on therapy, participants initiating cART in 1996–2000 had 5.5-times more 3TC/FTC ADR, 5.3-times more other nRTI ADR, 4.7-times more NNRTI ADR, and 24-times more PI ADR than those starting in 2011–2014. The individuals with highest odds of developing ADR in 1996–2010 were adherent to regimens at levels between 60% and 80%, which shifted to <40% adherent in 2011–2014. Conclusions: HIV drug resistance transitioned from being primarily selected de-novo to being driven by TDR. Among those who started treatment in the past 5 years, ADR is rare and observed mostly in the lowest adherence strata.
| Langue d'origine | English |
|---|---|
| Pages (de-à) | 185-191 |
| Nombre de pages | 7 |
| Journal | Clinical Microbiology and Infection |
| Volume | 24 |
| Numéro de publication | 2 |
| DOI | |
| Statut de publication | Published - févr. 2018 |
| Publié à l'externe | Oui |
Note bibliographique
Funding Information:Viviane Dias Lima has received limited unrestricted funding, paid to her institution, from GlaxoSmithKline in the past 36 months. She is supported by a Scholar Award from the Michael Smith Foundation for Health Research ( #5199 ), a New Investigator Award from Canadian Institutes of Health Research (CIHR) (#288880), and grants from the CIHR (MOP-125948; PJT-148595). Chanson J Brumme is supported by a Postgraduate Fellowship from CIHR ( MFE-146750 ). None of the other authors have conflicts to declare. The authors thank Providence Health Care; as well as Genome BC, Genome Canada, Genome Quebec, and Canadian Institutes of Health Research (CIHR) Partnership in Genomics and Personalized Health (Large-Scale Applied Research Project HIV142 contract to Dr. Richard Harrigan) for providing monetary support.
Funding Information:
Viviane Dias Lima has received limited unrestricted funding, paid to her institution, from GlaxoSmithKline in the past 36 months. She is supported by a Scholar Award from the Michael Smith Foundation for Health Research (#5199), a New Investigator Award from Canadian Institutes of Health Research (CIHR) (#288880), and grants from the CIHR (MOP-125948; PJT-148595). Chanson J Brumme is supported by a Postgraduate Fellowship from CIHR (MFE-146750). None of the other authors have conflicts to declare. The authors thank Providence Health Care; as well as Genome BC, Genome Canada, Genome Quebec, and Canadian Institutes of Health Research (CIHR) Partnership in Genomics and Personalized Health (Large-Scale Applied Research Project HIV142 contract to Dr. Richard Harrigan) for providing monetary support.
Publisher Copyright:
© 2017 European Society of Clinical Microbiology and Infectious Diseases
ASJC Scopus Subject Areas
- Microbiology (medical)
- Infectious Diseases
ODD de l’ONU
Cette action contribue à la réalisation des objectifs de développement durable suivants
