HIV resistance testing and detected drug resistance in Europe
Language English Country Great Britain, England Media print
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
- MeSH
- Adult MeSH
- Genotype MeSH
- HIV Infections drug therapy MeSH
- HIV-1 genetics MeSH
- HIV Protease Inhibitors therapeutic use MeSH
- Reverse Transcriptase Inhibitors therapeutic use MeSH
- Cohort Studies MeSH
- Anti-HIV Agents therapeutic use MeSH
- Middle Aged MeSH
- Humans MeSH
- Logistic Models MeSH
- Multivariate Analysis MeSH
- Treatment Failure MeSH
- CD4 Lymphocyte Count MeSH
- Drug Resistance, Viral genetics MeSH
- Viral Load drug effects MeSH
- Check Tag
- Adult MeSH
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
- Names of Substances
- HIV Protease Inhibitors MeSH
- Reverse Transcriptase Inhibitors MeSH
- Anti-HIV Agents MeSH
OBJECTIVES: To describe regional differences and trends in resistance testing among individuals experiencing virological failure and the prevalence of detected resistance among those individuals who had a genotypic resistance test done following virological failure. DESIGN: Multinational cohort study. METHODS: Individuals in EuroSIDA with virological failure (>1 RNA measurement >500 on ART after >6 months on ART) after 1997 were included. Adjusted odds ratios (aORs) for resistance testing following virological failure and aORs for the detection of resistance among those who had a test were calculated using logistic regression with generalized estimating equations. RESULTS: Compared to 74.2% of ART-experienced individuals in 1997, only 5.1% showed evidence of virological failure in 2012. The odds of resistance testing declined after 2004 (global P < 0.001). Resistance was detected in 77.9% of the tests, NRTI resistance being most common (70.3%), followed by NNRTI (51.6%) and protease inhibitor (46.1%) resistance. The odds of detecting resistance were lower in tests done in 1997-1998, 1999-2000 and 2009-2010, compared to those carried out in 2003-2004 (global P < 0.001). Resistance testing was less common in Eastern Europe [aOR 0.72, 95% confidence interval (CI) 0.55-0.94] compared to Southern Europe, whereas the detection of resistance given that a test was done was less common in Northern (aOR 0.29, 95% CI 0.21-0.39) and Central Eastern (aOR 0.47, 95% CI 0.29-0.76) Europe, compared to Southern Europe. CONCLUSIONS: Despite a concurrent decline in virological failure and testing, drug resistance was commonly detected. This suggests a selective approach to resistance testing. The regional differences identified indicate that policy aiming to minimize the emergence of resistance is of particular relevance in some European regions, notably in the countries in Eastern Europe.
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