Emergence of acquired HIV-1 drug resistance has almost been stopped in Switzerland - a 15 year prospective cohort analysis - Publication

Publication

Emergence of acquired HIV-1 drug resistance has almost been stopped in Switzerland - a 15 year prospective cohort analysis

Journal Paper/Review - Mar 8, 2016

Scherrer Alexandra U, Günthard Huldrych F, Bernasconi Enos, Vernazza Pietro, Calmy Alexandra, Furrer Hansjakob, Battegay Manuel, Cavassini Matthias, Aubert Vincent, Klimkait Thomas, Yerly Sabine, Böni Jürg, Kouyos Roger, Yang Wan-Lin, von Wyl Viktor

Citation

Scherrer A, Günthard H, Bernasconi E, Vernazza P, Calmy A, Furrer H, Battegay M, Cavassini M, Aubert V, Klimkait T, Yerly S, Böni J, Kouyos R, Yang W, von Wyl V. Emergence of acquired HIV-1 drug resistance has almost been stopped in Switzerland - a 15 year prospective cohort analysis. Clin Infect Dis 2016

Type

Journal Paper/Review (English)

Journal

Clin Infect Dis 2016

Publication Date

Mar 8, 2016

Issn Electronic

1537-6591

Brief description/objective

BACKGROUND
Drug resistance is a major barrier to successful antiretroviral treatment (ART). Therefore, it is important to monitor time trends at a population level.

METHODS
We included 11,084 ART-experienced patients from the Swiss HIV Cohort Study (SHCS) between 1999 and 2013. The SHCS is highly representative and includes 72% of patients receiving ART in Switzerland. Drug resistance was defined as the presence of at least one major mutation in a genotypic resistance test. To estimate the prevalence of drug resistance, data for patients with no resistance test was imputed based on patient's risk of harboring drug resistant viruses.

RESULTS
The emergence of new drug resistance mutations declined dramatically from 401 to 23 patients between 1999 and 2013. The upper estimated prevalence limit of drug resistance among ART-experienced patients decreased from 57.0% in 1999 to 37.1% in 2013. The prevalence of three-class resistance decreased from 9.0% to 4.4% and was always <0.4% for patients who initiated ART after 2006. Most patients actively participating in the SHCS in 2013 with drug resistant viruses initiated ART before 1999 (59.8%). Nevertheless, in 2013, 94.5% of patients who initiated ART before 1999 had good remaining treatment options based on Stanford algorithm.

CONCLUSION
HIV-1 drug resistance among ART-experienced patients in Switzerland is a well-controlled relic from the pre-combination ART era. Emergence of drug resistance can be virtually stopped with new potent therapies and close monitoring.