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Resistance testing required in treatment-naive HIV patients in US, UK
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Between 10% and 15% of treatment-naive HIV-positive patients in the United States and the United Kingdom have a transmitted drug-resistant form of HIV and are more than three times likely to result in treatment failure, according to findings published in The Lancet Infectious Diseases.
“This is the first study we know of to distinguish between patients who present with drug resistance who are receiving fully active combination antiretroviral therapy (cART) and those who received at least one drug predicted to have low-level drug resistance on the basis of the WHO list for transmitted drug resistance (TDR),” the researchers wrote.
Linda Wittkop, MD, of the University Bordeaux Segalen in France, and colleagues assessed the effect of TDR on virological and immunological response during the first year of cART among 10,056 HIV-1 positive patients included in the EuroCoord-CHAIN study. Participants were HIV-positive, initiated cART for the first time in 1998, were antiretroviral-naive, and had at least one sample for genotypic testing taken before the start of cART.
Patients were classified into three resistance categories: No TDR, at least one mutation and cART, or at least one mutation and resistance to at least one prescribed drug.
Data indicated that 90.5% of patients had HIV without TDR; 4.8% had at least one mutation and resistance to at least one drug; and 4.7% had at least one mutation, but received cART, according the researchers. Moreover, estimates for virological failure at 1 year were 4.2% in patients with no TDR; 4.7% for those with TDR and cART; and 15.1% for those with TDR and drug-resistance (P?.0001).
Compared with patients without TDR, the HR for patients with TDR and resistance to at least one drug was 3.13 (95% CI, 2.33-4.20); 1.47 among those with TDR receiving cART (95% CI, 0.19-2.38); and was 2.0 for the risk for virological failure among those with TDR who received cART combined with a non-nucleoside reverse-transcriptase inhibitor (95% CI, 0.9-4.7).
“Overall, the risk for virological failure in patients with TDR who received cART was not significantly different to that in patients with no TDR,” the researchers wrote. “Patients who received a treatment regimen with a low genetic barrier had weak evidence for higher-risk for virological failure in the presence of TDR and when they received treatment predicted to be fully active compared with those in the no TDR group. These findings confirm present treatment guidelines for HIV, which state that the initial treatment choice should be based on resistance testing in treatment-naive patients.”
For more information:
- Wittkop L. Lancet Infect Dis. 2011;doi:10.1016/S1473-3099(11)70032-9.