Time trends in primary resistance to HIV drugs in the United Kingdom: multicentre observational study

Abstract Objective To examine whether the level of primary resistance to HIV drugs is increasing in the United Kingdom. Design Multicentre observational study. Setting All virology laboratories in the United Kingdom carrying out tests for HIV resistance as part of routine clinical care. Participants 2357 people infected with HIV who were tested for resistance before receiving antiretroviral therapy. Main outcome measure Prevalence of drug resistance on basis of the Stanford genotypic interpretation system. Results Over the study period (February 1996 to May 2003), 335 (14.2%, 95% confidence interval 12.8% to 15.7%) samples had mutations that conferred resistance to one or more antiretroviral drugs (9.3% high level resistance, 5.9% medium level resistance). The prevalence of primary resistance has increased markedly over time, although patterns are specific to drug class; the largest increase was for non-nucleoside reverse transcriptase inhibitors. In 2002-3, the prevalence of resistance to any antiretroviral drug to nucleoside or nucleotide reverse transcriptase inhibitors, to non-nucleoside reverse transcriptase inhibitors, or to protease inhibitors was 19.2% (15.7% to 23.2%), 12.4% (9.5% to 15.9%), 8.1% (5.8% to 11.1%), and 6.6% (4.4% to 9.3%), respectively. The risk of primary resistance was only weakly related to most demographic and clinical factors, including ethnicity and viral subtype. Conclusions The United Kingdom has one of the highest reported rates of primary resistance to HIV drugs worldwide. Prevalence seems still to be increasing and is high in all demographic subgroups.

[1]  Klaus Korn,et al.  Prevalence of drug-resistant HIV-1 variants in untreated individuals in Europe: implications for clinical management. , 2005, The Journal of infectious diseases.

[2]  F. Brun-Vézinet,et al.  French National Sentinel Survey of Antiretroviral Drug Resistance in Patients With HIV-1 Primary Infection and in Antiretroviral-Naive Chronically Infected Patients in 2001-2002 , 2005, Journal of acquired immune deficiency syndromes.

[3]  B. Gazzard,et al.  Treatment exhaustion of highly active antiretroviral therapy (HAART) among individuals infected with HIV in the United Kingdom: multicentre cohort study , 2005, BMJ : British Medical Journal.

[4]  JD Lundgren,et al.  Updated European Recommendations for the Clinical Use of HIV Drug Resistance Testing , 2004, Antiviral therapy.

[5]  I. Williams,et al.  Development of a novel human immunodeficiency virus type 1 subtyping tool, Subtype Analyzer (STAR): analysis of subtype distribution in London. , 2004, AIDS research and human retroviruses.

[6]  F. Chiodo,et al.  Variability in the Interpretation of Transmitted Genotypic HIV-1 Drug Resistance and Prediction of Virological Outcomes of the Initial Haart by Distinct Systems , 2004, Antiviral therapy.

[7]  Kholoud Porter,et al.  The creation of a large UK‐based multicentre cohort of HIV‐infected individuals: The UK Collaborative HIV Cohort (UK CHIC) Study , 2004, HIV medicine.

[8]  J. Parry,et al.  HIV incidence appears constant in men who have sex with men despite widespread use of effective antiretroviral therapy , 2004, AIDS.

[9]  D. Watson-Jones,et al.  Extensive antiretroviral therapy resistance in an HIV-infected Zimbabwean patient in the UK. , 2003, AIDS.

[10]  D. Cooper,et al.  No increase in protease resistance and a decrease in reverse transcriptase resistance mutations in primary HIV-1 infection: 1992-2001. , 2003, AIDS.

[11]  Elizabeth Connick,et al.  Antiretroviral-drug resistance among patients recently infected with HIV. , 2002, The New England journal of medicine.

[12]  J. Kahn,et al.  Time trends in primary HIV-1 drug resistance among recently infected persons. , 2002, JAMA.

[13]  J P Bru,et al.  Acute HIV infection: impact on the spread of HIV and transmission of drug resistance , 2001, AIDS.

[14]  P. Easterbrook,et al.  Prevalence of antiretroviral resistance in a South London cohort of treatment-naive HIV-1-infected patients. , 2001, AIDS.

[15]  D. Pillay,et al.  Analysis of prevalence of HIV-1 drug resistance in primary infections in the United Kingdom , 2001, BMJ : British Medical Journal.

[16]  V. Beral,et al.  The AIDS incubation period in the UK estimated from a national register of HIV seroconverters , 1998, AIDS.

[17]  D. Richman,et al.  Update of the drug resistance mutations in HIV-1: 2004. , 2004, Topics in HIV medicine : a publication of the International AIDS Society, USA.