engleski

The burden of transmitted drug resistance in clinical practice in Europe is increasing over time despite a stable prevalence

Objectives: In the last decade, we showed that 1 in 10 patients newly diagnosed with HIV-1 in Europe is infected with a virus that harbours transmitted drug resistance mutations (TDR). We estimated the proportion and total number of HIV-1 diagnoses with TDR in Europe over time. Methods: Clinical and virological data from 8479 patients within 6 months of diagnosis with HIV-1 in 2002-2010 were analyzed. TDR (as defined by the 2009 WHO list) was determined for all 26 countries as the weighted sum of the prevalence per risk group per country, considering their share in the European HIV-1 epidemic. To estimate the annual number of HIV-1 diagnoses with TDR for the 19 countries that participated in surveillance since 2003 (Austria, Belgium, Cyprus, Czech Republic, Denmark, Finland, Germany, Greece, Ireland, Israel, Italy, Luxembourg, Netherlands, Norway, Poland, Serbia, Slovenia, Spain, Sweden), the weighted prevalence was multiplied by their total number of new HIV-1 diagnoses as reported by ECDC. Results: In 2008-2010, the prevalence of TDR was 9.2% (95%CI:7.3-11.1). Mutations associated with resistance to NRTIs were observed most frequently (5.1% ; 95%CI: 3.6-6.6), followed by NNRTIs (3.7% ; 95%CI: 2.3-5.0) and PIs (2.3% ; 95%CI: 1.3-3.2). Given the increasing number of HIV-1 diagnoses in these 19 countries, the estimated annual number of new diagnoses with HIV-TDR increased from 1010 (95% CI: 876-1144) in 2003-2005 to 1370 (95%CI:1127-1613) in 2008-2010 (p0.01). The increasing number of new diagnoses with NNRTI-resistance mutations (336 (95%CI:255-418) in 2003-2005 to 550 (95%CI:376-724) in 2008-2010 ; p0.03) is of particular concern, considering these mutations generally confer high-level resistance to NNRTIs that are frequently used as first-line therapy. Conclusion: Although the proportion of new HIV-1 diagnoses with TDR remains stable around 10%, the burden of TDR in clinical practices is increasing, underlining the importance of baseline genotypic testing and continuance of surveillance of TDR.

transmitted drug resistance; clinical practice; Europe; prevalence

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