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HIV-1 subtype B-infected MSM may have driven the spread of transmitted resistant strains in France in 2007-12: impact on susceptibility to first-line strategies
Published by Pedro CAHN

Updated: 15 June, 2015

Frange P et al. J Antimicrob Chemother. 2015 Jul;70(7):2084-9.

The study describes the prevalence of transmitted drug resistance among 1,318 French patients diagnosed at the time of primary HIV-1 infection in 2007-2012. HIV-1 resistance-associated mutations were characterized using both the 2009 WHO list of mutations and the French ANRS algorithm. A genotypic susceptibility score was estimated for each first-line recommended antiretroviral therapy combination. Patients were mainly MSM (72.6%). Non-B subtypes were identified in 33.7% of patients.

The proportion of transmitted drug resistance was estimated as 11.7% (95% CI 10.0-13.5). The prevalence of PI (NRTI), first-generation NNRTI and etravirine/rilpivirine resistance-associated mutations were 2.5%, 5.2%, 3.9% and 3.2%, respectively. Single, dual and triple class resistance was found in 9.6%, 1.0% and 1.1% of cases, respectively. Additionally, 5/331 strains isolated in 2010-2012 had integrase inhibitor-related resistance-associated mutations (isolated E157Q mutation in all cases). Transmitted drug resistance was more common among MSM than in other groups (12.9% versus 8.6%, p = 0.034), and in case of B versus non-B subtype infections (13.6% versus 7.9%, p = 0.002). The proportions of fully active combinations were ≥ 99.2%, ≥ 9 7.3% and ≥ 95.3% for PI, integrase inhibitor, and NNRTI-based regimens, respectively. In 2010-2012, the proportion of fully active efavirenz-based antiretroviral therapy was lower in cases of subtype B versus non-B infection (p = 0.021).

Compared to previous results, the proportion of NRTI and first-generation NNRTI-related transmitted drug resistance has continued to decline in French seroconverters. However, subtype B-infected MSM could drive the spread of resistant HIV strains.