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Emergence of Drug Resistance in the Swiss HIV Cohort Study Under Potent Antiretroviral Therapy Is Observed in Socially Disadvantaged Patients

Irene A Abela, Alexandra U Scherrer, Jürg Böni, Sabine Yerly, Thomas Klimkait, Matthieu Perreau, Hans H Hirsch, Hansjakob Furrer, Alexandra Calmy, Patrick Schmid, Matthias Cavassini, Enos Bernasconi, Huldrych F Günthard & Swiss HIV Cohort Study

abstract

BACKGROUND
The rate of acquired human immunodeficiency virus type 1 (HIV-1) drug resistance (ADR) has fallen dramatically since introduction of combined antiretroviral therapy (cART) in Switzerland. However, clinical experience indicates that there are still patients at risk of newly acquiring drug resistance despite having access to cART. Here, we characterized risk factors for ADR, to improve patient care and prevent emergence of drug resistance and treatment failure.

METHODS
We performed a case-control study to identify risk factors for ADR in all patients starting their first cART in the Swiss HIV Cohort Study (SHCS) since 1996. The SHCS is highly representative and includes >75% of patients receiving ART in Switzerland. To this end, we implemented a systematic medical chart review to obtain more detailed information on additional parameters, which are not routinely collected in the SHCS. The collected data were analyzed using univariable and multivariable conditional logistic regression.

RESULTS
We included in our study 115 cases and 115 matched controls. Unemployment (multivariable odds ratio [mOR], 2.9 [95% confidence interval {CI}, 1.3-6.4]; P = .008), African origin (mOR, 3.0 [95% CI, 1.0-9.2]; P = .047), comedication with anti-infectives (mOR, 3.7 [95% CI, 1.0-12.6]; P = .045), and symptoms of mental illness (mOR, 2.6 [95% CI, 1.2-5.5]; P = .012) were associated with ADR in the multivariable model.

CONCLUSIONS
Although ADR has become very rare with cART due to new potent therapies, patients in socially challenging life situations or presenting with mental health issues are at higher risk for drug resistance. Prompt identification and adequate support of these patients before ADR will prevent treatment failure and HIV-1 transmission.
   
citation Abela I A, Scherrer A U, Böni J, Yerly S, Klimkait T, Perreau M, Hirsch H H, Furrer H, Calmy A, Schmid P, Cavassini M, Bernasconi E, Günthard H F, Swiss HIV Cohort Study . Emergence of Drug Resistance in the Swiss HIV Cohort Study Under Potent Antiretroviral Therapy Is Observed in Socially Disadvantaged Patients. Clin Infect Dis 2020; 70:297-303.
   
type journal paper/review (English)
date of publishing 02-1-2020
journal title Clin Infect Dis (70/2)
ISSN electronic 1537-6591
pages 297-303
PubMed 30843028
DOI 10.1093/cid/ciz178