Prevalence of Drug‐Resistant HIV‐1 Variants in Untreated Individuals in Europe: Implications for Clinical Management

TLDR

Drug‑resistant HIV‑1 infection can compromise antiretroviral therapy effectiveness and widespread transmission threatens future treatment options and post‑exposure prophylaxis efficacy. Among 2,208 therapy‑naive European patients, 10 % carried ≥1 resistance mutation, with higher rates in recently infected (13.5 % vs 8.7 %) and subtype B viruses (12.9 % vs 4.8 %), and rising baseline resistance in non‑B strains over time, underscoring the need for universal resistance testing.

Abstract

Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) can impair the response to combination therapy. Widespread transmission of drug-resistant variants has the disturbing potential of limiting future therapy options and affecting the efficacy of postexposure prophylaxis.We determined the baseline rate of drug resistance in 2208 therapy-naive patients recently and chronically infected with HIV-1 from 19 European countries during 1996-2002.In Europe, 1 of 10 antiretroviral-naive patients carried viruses with > or = 1 drug-resistance mutation. Recently infected patients harbored resistant variants more often than did chronically infected patients (13.5% vs. 8.7%; P=.006). Non-B viruses (30%) less frequently carried resistance mutations than did subtype B viruses (4.8% vs. 12.9%; P<.01). Baseline resistance increased over time in newly diagnosed cases of non-B infection: from 2.0% (1/49) in 1996-1998 to 8.2% (16/194) in 2000-2001.Drug-resistant variants are frequently present in both recently and chronically infected therapy-naive patients. Drug-resistant variants are most commonly seen in patients infected with subtype B virus, probably because of longer exposure of these viruses to drugs. However, an increase in baseline resistance in non-B viruses is observed. These data argue for testing all drug-naive patients and are of relevance when guidelines for management of postexposure prophylaxis and first-line therapy are updated.