| Long-term trends of HIV type 1 drug resistance prevalence among antiretroviral treatment-experienced patients in Switzerland. | |
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MedLine Citation:
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PMID: 19228107 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND:Accurate quantification of the prevalence of human immunodeficiency virus type 1 (HIV-1) drug resistance in patients who are receiving antiretroviral therapy (ART) is difficult, and results from previous studies vary. We attempted to assess the prevalence and dynamics of resistance in a highly representative patient cohort from Switzerland. METHODS:On the basis of genotypic resistance test results and clinical data, we grouped patients according to their risk of harboring resistant viruses. Estimates of resistance prevalence were calculated on the basis of either the proportion of individuals with a virologic failure or confirmed drug resistance (lower estimate) or the frequency-weighted average of risk group-specific probabilities for the presence of drug resistance mutations (upper estimate). RESULTS:Lower and upper estimates of drug resistance prevalence in 8064 ART-exposed patients were 50% and 57% in 1999 and 37% and 45% in 2007, respectively. This decrease was driven by 2 mechanisms: loss to follow-up or death of high-risk patients exposed to mono- or dual-nucleoside reverse-transcriptase inhibitor therapy (lower estimates range from 72% to 75%) and continued enrollment of low-risk patients who were taking combination ART containing boosted protease inhibitors or nonnucleoside reverse-transcriptase inhibitors as first-line therapy (lower estimates range from 7% to 12%). A subset of 4184 participants (52%) had >or= 1 study visit per year during 2002-2007. In this subset, lower and upper estimates increased from 45% to 49% and from 52% to 55%, respectively. Yearly increases in prevalence were becoming smaller in later years. CONCLUSIONS:Contrary to earlier predictions, in situations of free access to drugs, close monitoring, and rapid introduction of new potent therapies, the emergence of drug-resistant viruses can be minimized at the population level. Moreover, this study demonstrates the necessity of interpreting time trends in the context of evolving cohort populations. |
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Authors:
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Viktor von Wyl; Sabine Yerly; Philippe Bürgisser; Thomas Klimkait; Manuel Battegay; Enos Bernasconi; Matthias Cavassini; Hansjakob Furrer; Bernard Hirschel; Pietro L Vernazza; Patrick Francioli; Sebastian Bonhoeffer; Bruno Ledergerber; Huldrych F Günthard; |
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Publication Detail:
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Type: Journal Article; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: Clinical infectious diseases : an official publication of the Infectious Diseases Society of America Volume: 48 ISSN: 1537-6591 ISO Abbreviation: Clin. Infect. Dis. Publication Date: 2009 Apr |
Date Detail:
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Created Date: 2009-03-09 Completed Date: 2009-04-13 Revised Date: 2010-09-14 |
Medline Journal Info:
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Nlm Unique ID: 9203213 Medline TA: Clin Infect Dis Country: United States |
Other Details:
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Languages: eng Pagination: 979-87 Citation Subset: IM |
Affiliation:
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Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, ETH Zurich, Zurich, Switzerland. vowv@usz.uzh.ch |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adult Anti-HIV Agents / therapeutic use Drug Resistance, Viral* Female Genotype HIV Infections / drug therapy*, epidemiology, virology* HIV-1 / drug effects*, genetics Humans Male Middle Aged Prevalence Switzerland / epidemiology Young Adult |
| Chemical | |
Reg. No./Substance:
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0/Anti-HIV Agents |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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