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Trends in HIV-drug resistant transmission stabilized
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ATLANTA — One-in-six genetic sequences obtained from newly diagnosed HIV patients in the United States contained drug-resistant mutations related to three different classes of HIV drugs, researchers reported here. The rate of HIV-drug resistant transmissions has not increased significantly from 2007.
“This report highlights two important concepts,” study researcher David Kim, MD, a CDC medical officer, said during his presentation. “One, it underscores the importance of HIV genotype testing for newly diagnosed HIV-infected patients. More broadly, it emphasizes the need for continuity of HIV drug-resistance surveillance.”
David Kim*
Kim and colleagues obtained HIV-1 nucleotide sequence data from 18,144 patients newly diagnosed with HIV who had not been treated with antiretroviral drugs. Data were collected from 10 states and large cities from 2007 to 2010. The researchers applied the CDC’s HIV-1 mutation list — used for surveillance — to the sequence data to identify transmitted drug resistance-associated mutations (TDRMs) related to three drug classes: non-nucleoside reverse transcriptase inhibitors (NNRTIs), nucleoside reverse transcriptase inhibitors (NRTIs) and protease inhibitors. They also calculated the estimated annual percentage change to assess trends in TDRMs.
Of the 18,144 sequences, 2,932 (16.2%) contained 4,788 TDRMs associated with any of the three drug classes. According to the researchers, 2,461 (13.6%) of these sequences had TDRMs for a single drug class, 386 (2.1%) for two drug classes, and 85 (0.5%) for three drug classes. TDRMs associated with NNRTIs were located in 1,464 (8.1%) sequences, NRTIs in 1,206 (6.7%) sequences, and protease inhibitors in 818 (4.5%) sequences.
Although the estimated annual percentage change for any TDRMs was not significant (3%; P=.06), the researchers found a significant percentage change for TDRMs related to a single drug class (4.3%; P=.01) and for TDRMs related to NNRTIs (5.2%; P=.03).
“Continued monitoring of HIV drug resistance can help tell us what the national, regional or perhaps global trends in HIV drug resistance might look like, particularly as new drugs and new classes of drugs come on the market,” Kim said. – by John Schoen
For more information:
Kim D. #149. Presented at: 2013 Conference on Retroviruses and Opportunistic Infections; March 3-6, 2013; Atlanta.
*Photograph courtesy of Matt Alexandre.
David Kim, MD, can be reached at dkim@cdc.gov.
Disclosure: Kim reports no relevant financial disclosures.
Perspective
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Paul A. Volberding, MD
If antiretroviral treatment fails to completely suppress viremia, drug resistance mutations may be selected. These can then be transmitted to others. There has long been a fear that HIV resistance in the community will become more common, as we have all seen in antibacterial drugs. This has fortunately not happened, although a low background of HIV resistance has persisted. This probably reflects the very high potency of current therapy and improved adherence made possible by more convenient and less toxic regimens. While HIV transmissions continue, they are often from persons not on treatment. Still, as this paper notes, vigilance is needed to ensure that decisions regarding initial drug regimens consider the possibility that one or more resistance mutations may have been transmitted.
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