Recent trends and patterns in HIV-1 transmitted drug resistance in the United Kingdom

A Tostevin; E White; D Dunn; S Croxford; V Delpech; I Williams; D Asboe; A Pozniak; D Churchill; A M Geretti; D Pillay; C Sabin; A Leigh-Brown; E Smit; UK HIV Drug Resistance Database

doi:10.1111/hiv.12414

Recent trends and patterns in HIV-1 transmitted drug resistance in the United Kingdom

HIV Med. 2017 Mar;18(3):204-213. doi: 10.1111/hiv.12414. Epub 2016 Aug 1.

Authors

A Tostevin¹, E White¹, D Dunn¹, S Croxford², V Delpech², I Williams³, D Asboe⁴, A Pozniak⁴, D Churchill⁵, A M Geretti⁶, D Pillay^{7

8}, C Sabin⁹, A Leigh-Brown¹⁰, E Smit¹¹; UK HIV Drug Resistance Database

Collaborators

UK HIV Drug Resistance Database:
Celia Aitken, Patricia Cane, David Chadwick, Duncan Clark, Simon Collins, Samuel Douthwaite, Esther Fearnhill, Kholoud Porter, Christophe Fraser, Antony Hale, Stéphane Hué, Steve Kaye, Paul Kellam, Linda Lazarus, Tamyo Mbisa, Nicola Mackie, Samuel Moses, Chloe Orkin, Eleni Nastouli, Andrew Phillips, Kate Templeton, Peter Tilston, Hongyi Zhang, Keith Fairbrother, Jane Greatorex, Siobhan O'Shea, Jane Mullen, Alison Cox, Richard Tandy, Tracy Fawcett, Mark Hopkins, Lynne Ashton, Clare Booth, Ana Garcia-Diaz, Jill Shepherd, Matthias L Schmid, Brendan Payne, Spiro Pereira, Jonathan Hubb, Stuart Kirk, Rory Gunson, Amanda Bradley-Stewart

Affiliations

¹ MRC Clinical Trials Unit at UCL, University College London, London, UK.
² Centre for Infectious Disease Surveillance and Control (CIDSC), Public Health England, London, UK.
³ Mortimer Market Centre, University College London Hospitals NHS Trust, London, UK.
⁴ Chelsea & Westminster Hospital, London, UK.
⁵ Brighton and Sussex University Hospitals NHS Trust, Brighton, UK.
⁶ University of Liverpool, Liverpool, UK.
⁷ Division of Infection and Immunity, University College London, London, UK.
⁸ Africa Centre for Health and Population Studies, University of KwaZulu-Natal, Mtubatuba, South Africa.
⁹ Research Department of Infection and Population Health, University College London, London, UK.
¹⁰ University of Edinburgh, Edinburgh, UK.
¹¹ Public Health England, Birmingham Heartlands Hospital, Birmingham, UK.

Abstract

Objectives: Transmission of drug-resistant HIV-1 has decreased in the UK since the early 2000s. This analysis reports recent trends and characteristics of transmitted drug resistance (TDR) in the UK from 2010 to 2013.

Methods: Resistance tests conducted in antiretroviral treatment (ART)-naïve individuals between 2010 and 2013 were analysed for the presence of transmitted drug resistance mutations (TDRMs), defined as any mutations from a modified 2009 World Health Organization surveillance list, or a modified 2013 International Antiviral Society-USA list for integrase tests. Logistic regression was used to examine associations between demographics and the prevalence of TDRMs.

Results: TDRMs were observed in 1223 (7.5%) of 16 425 individuals; prevalence declined from 8.1% in 2010 to 6.6% in 2013 (P = 0.02). The prevalence of TDRMs was higher among men who have sex with men (MSM) compared with heterosexual men and women (8.7% versus 6.4%, respectively) with a trend for decreasing TDRMs among MSM (P = 0.008) driven by a reduction in nucleoside reverse transcriptase inhibitor (NRTI)-related mutations. The most frequently detected TDRMs were K103N (2.2%), T215 revertants (1.6%), M41L (0.9%) and L90M (0.7%). Predicted phenotypic resistance to first-line ART was highest to the nonnucleoside reverse transcriptase inhibitors (NNRTIs) rilpivirine and efavirenz (6.2% and 3.4%, respectively) but minimal to NRTIs, including tenofovir, and protease inhibitors (PIs). No major integrase TDRMs were detected among 101 individuals tested while ART-naïve.

Conclusions: We observed a decrease in TDRMs in recent years. However, this was confined to the MSM population and rates remained stable in those with heterosexually acquired HIV infection. Resistance to currently recommended first-line ART, including integrase inhibitors, remained reassuringly low.

Keywords: HIV-1; drug resistance; mutations; transmitted; transmitted drug resistance; transmitted drug resistance mutations.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adolescent
Adult
Anti-Retroviral Agents / pharmacology*
Cohort Studies
Disease Transmission, Infectious*
Drug Resistance, Viral*
Female
HIV Infections / transmission*
HIV Infections / virology*
HIV-1 / drug effects*
HIV-1 / isolation & purification
Humans
Male
Middle Aged
Prevalence
United Kingdom / epidemiology
Young Adult

Substances

Anti-Retroviral Agents

Abstract

Publication types

MeSH terms

Substances

Grants and funding