UNIGE document Scientific Article
previous document  unige:7678  next document
add to browser collection
Title

Long-term trends of HIV type 1 drug resistance prevalence among antiretroviral treatment-experienced patients in Switzerland

Authors
von Wyl, Viktor
Burgisser, Philippe
Klimkait, Thomas
Battegay, Manuel
Cavassini, Matthias
Furrer, Hansjakob
show hidden authors show all authors [1 - 15]
Published in Clinical Infectious Diseases. 2009, vol. 48, no. 7, p. 979-987
Abstract BACKGROUND:Accurate quantification of the prevalence of human immunodeficiency virus type 1 (HIV-1) drug resistance in patients who are receiving antiretroviral therapy (ART) is difficult, and results from previous studies vary. We attempted to assess the prevalence and dynamics of resistance in a highly representative patient cohort from Switzerland. METHODS:On the basis of genotypic resistance test results and clinical data, we grouped patients according to their risk of harboring resistant viruses. Estimates of resistance prevalence were calculated on the basis of either the proportion of individuals with a virologic failure or confirmed drug resistance (lower estimate) or the frequency-weighted average of risk group-specific probabilities for the presence of drug resistance mutations (upper estimate). RESULTS:Lower and upper estimates of drug resistance prevalence in 8064 ART-exposed patients were 50% and 57% in 1999 and 37% and 45% in 2007, respectively. This decrease was driven by 2 mechanisms: loss to follow-up or death of high-risk patients exposed to mono- or dual-nucleoside reverse-transcriptase inhibitor therapy (lower estimates range from 72% to 75%) and continued enrollment of low-risk patients who were taking combination ART containing boosted protease inhibitors or nonnucleoside reverse-transcriptase inhibitors as first-line therapy (lower estimates range from 7% to 12%). A subset of 4184 participants (52%) had >or= 1 study visit per year during 2002-2007. In this subset, lower and upper estimates increased from 45% to 49% and from 52% to 55%, respectively. Yearly increases in prevalence were becoming smaller in later years. CONCLUSIONS:Contrary to earlier predictions, in situations of free access to drugs, close monitoring, and rapid introduction of new potent therapies, the emergence of drug-resistant viruses can be minimized at the population level. Moreover, this study demonstrates the necessity of interpreting time trends in the context of evolving cohort populations.
Keywords AdultAnti-HIV Agents/therapeutic useDrug Resistance, ViralFemaleGenotypeHIV Infections/ drug therapy/epidemiology/ virologyHIV-1/ drug effects/geneticsHumansMaleMiddle AgedPrevalenceSwitzerland/epidemiologyYoung Adult
Identifiers
PMID: 19228107
Full text
Article - document accessible for UNIGE members only Limited access to UNIGE
Other version: http://www.journals.uchicago.edu/doi/pdf/10.1086/597352
Structures
Citation
(ISO format)
VON WYL, Viktor et al. Long-term trends of HIV type 1 drug resistance prevalence among antiretroviral treatment-experienced patients in Switzerland. In: Clinical Infectious Diseases, 2009, vol. 48, n° 7, p. 979-987. https://archive-ouverte.unige.ch/unige:7678

173 hits

0 download

Update

Deposited on : 2010-06-21

Export document
Format :
Citation style :