HIV resistance testing and detected drug resistance in Europe

Anna Schultze; Andrew N Phillips; Roger Paredes; Manuel Battegay; Jürgen K Rockstroh; Ladislav Machala; Janez Tomazic; Pierre M Girard; Inga Januskevica; Kamilla Gronborg-Laut; Jens D Lundgren; Alessandro Cozzi-Lepri; EuroSIDA in EuroCoord

doi:10.1097/qad.0000000000000708

HIV resistance testing and detected drug resistance in Europe

Anna Schultze, Andrew N Phillips, Roger Paredes, Manuel Battegay, Jürgen K Rockstroh, Ladislav Machala, Janez Tomazic, Pierre M Girard, Inga Januskevica, Kamilla Gronborg-Laut, Jens D Lundgren, Alessandro Cozzi-Lepri, EuroSIDA in EuroCoord

Department of Clinical Medicine

12 Citations (Scopus)

Abstract

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.

Original language	English
Journal	AIDS
Volume	29
Issue number	11
Pages (from-to)	1379-89
Number of pages	11
ISSN	0269-9370
DOIs	https://doi.org/10.1097/qad.0000000000000708
Publication status	Published - 17 Jul 2015

Keywords

Adult
Anti-HIV Agents
CD4 Lymphocyte Count
Cohort Studies
Drug Resistance, Viral
Europe
Female
Genotype
HIV Infections
HIV Protease Inhibitors
HIV-1
Humans
Logistic Models
Male
Middle Aged
Multivariate Analysis
Reverse Transcriptase Inhibitors
Treatment Failure
Viral Load

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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https://pdfs.journals.lww.com/aidsonline/2015/07170/HIV_resistance_testing_and_detected_drug.13.pdf?token=method|ExpireAbsolute;source|Journals;ttl|1543051347659;payload|mY8D3u1TCCsNvP5E421JYK6N6XICDamxByyYpaNzk7FKjTaa1Yz22MivkHZqjGP4kdS2v0J76WGAnHACH69s21Csk0OpQi3YbjEMdSoz2UhVybFqQxA7lKwSUlA502zQZr96TQRwhVlocEp/sJ586aVbcBFlltKNKo+tbuMfL73hiPqJliudqs17cHeLcLbV/CqjlP3IO0jGHlHQtJWcICDdAyGJMnpi6RlbEJaRheGeh5z5uvqz3FLHgPKVXJzdN2ziiHhY6wPF9tfA80jungnmgkEOnbXXPJ6Y9CFf8Wo=;hash|dBcbozLs0n5xxphy+LPJWg==

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@article{133e5dd15ec84d7598cf6df066f950ec,

title = "HIV resistance testing and detected drug resistance in Europe",

abstract = "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.",

keywords = "Adult, Anti-HIV Agents, CD4 Lymphocyte Count, Cohort Studies, Drug Resistance, Viral, Europe, Female, Genotype, HIV Infections, HIV Protease Inhibitors, HIV-1, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Reverse Transcriptase Inhibitors, Treatment Failure, Viral Load",

author = "Anna Schultze and Phillips, {Andrew N} and Roger Paredes and Manuel Battegay and Rockstroh, {J{\"u}rgen K} and Ladislav Machala and Janez Tomazic and Girard, {Pierre M} and Inga Januskevica and Kamilla Gronborg-Laut and Lundgren, {Jens D} and Alessandro Cozzi-Lepri and {EuroSIDA in EuroCoord}",

year = "2015",

month = jul,

day = "17",

doi = "10.1097/qad.0000000000000708",

language = "English",

volume = "29",

pages = "1379--89",

journal = "AIDS, Supplement",

issn = "1350-2840",

publisher = "Lippincott Williams & Wilkins",

number = "11",

}

TY - JOUR

T1 - HIV resistance testing and detected drug resistance in Europe

AU - Schultze, Anna

AU - Phillips, Andrew N

AU - Paredes, Roger

AU - Battegay, Manuel

AU - Rockstroh, Jürgen K

AU - Machala, Ladislav

AU - Tomazic, Janez

AU - Girard, Pierre M

AU - Januskevica, Inga

AU - Gronborg-Laut, Kamilla

AU - Lundgren, Jens D

AU - Cozzi-Lepri, Alessandro

AU - EuroSIDA in EuroCoord

PY - 2015/7/17

Y1 - 2015/7/17

N2 - 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.

AB - 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.

KW - Adult

KW - Anti-HIV Agents

KW - CD4 Lymphocyte Count

KW - Cohort Studies

KW - Drug Resistance, Viral

KW - Europe

KW - Female

KW - Genotype

KW - HIV Infections

KW - HIV Protease Inhibitors

KW - HIV-1

KW - Humans

KW - Logistic Models

KW - Male

KW - Middle Aged

KW - Multivariate Analysis

KW - Reverse Transcriptase Inhibitors

KW - Treatment Failure

KW - Viral Load

U2 - 10.1097/qad.0000000000000708

DO - 10.1097/qad.0000000000000708

M3 - Journal article

C2 - 26091300

SN - 1350-2840

VL - 29

SP - 1379

EP - 1389

JO - AIDS, Supplement

JF - AIDS, Supplement

IS - 11

ER -

HIV resistance testing and detected drug resistance in Europe

Abstract

Keywords

UN SDGs

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