title: Increase of transmitted drug resistance among HIV-infected sub-Saharan Africans residing in Spain in contrast to the native population.
abstract: BACKGROUND
  The prevalence of transmitted HIV drug resistance (TDR) is stabilizing or decreasing in developed countries. However, this trend is not specifically evaluated among immigrants from regions without well-implemented antiretroviral strategies.
  
  
  METHODS
  TDR trends during 1996-2010 were analyzed among naïve HIV-infected patients in Spain, considering their origin and other factors. TDR mutations were defined according to the World Health Organization list.
  
  
  RESULTS
  Pol sequence was available for 732 HIV-infected patients: 292 native Spanish, 226 sub-Saharan Africans (SSA), 114 Central-South Americans (CSA) and 100 from other regions. Global TDR prevalence was 9.7% (10.6% for Spanish, 8.4% for SSA and 7.9% for CSA). The highest prevalences were found for protease inhibitors (PI) in Spanish (3.1%), for non-nucleoside reverse transcriptase inhibitors (NNRTI) in SSA (6.5%) and for nucleoside reverse transcriptase inhibitors (NRTI) in both Spanish and SSA (6.5%). The global TDR rate decreased from 11.3% in 2004-2006 to 8.4% in 2007-2010. Characteristics related to a decreasing TDR trend in 2007-10 were Spanish and CSA origin, NRTI- and NNRTI-resistance, HIV-1 subtype B, male sex and infection through injection drug use. TDR remained stable for PI-resistance, in patients infected through sexual intercourse and in those carrying non-B variants. However, TDR increased among SSA and females. K103N was the predominant mutation in all groups and periods.
  
  
  CONCLUSIONS
  TDR prevalence tended to decrease among HIV-infected native Spanish and Central-South Americans, but it increased up to 13% in sub-Saharan immigrants in 2007-2010. These results highlight the importance of a specific TDR surveillance among immigrants to prevent future therapeutic failures, especially when administering NNRTIs.
authors: HIV-1 Molecular Epidemiology Laboratory, Microbiology Department, IRYCIS-Hospital Ramón y Cajal and CIBER-ESP, Madrid, Spain.
authors: Gonzalo
authors: G
authors: Yebra
authors: Miguel
authors: M
authors: de Mulder
authors: María Jesús
authors: MJ
authors: Pérez-Elías
authors: José Antonio
authors: JA
authors: Pérez-Molina
authors: Juan Carlos
authors: JC
authors: Galán
authors: Jara
authors: J
authors: Llenas-García
authors: Santiago
authors: S
authors: Moreno
authors: África
authors: Á
authors: Holguín
mesh_terms: D017954:Africa South of the Sahara / Q000208:ethnology; D000998:Antiviral Agents / Q000494:pharmacology; D024882:Drug Resistance, Viral / Q000235:genetics*; D054242:Emigrants and Immigrants; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission*; D006801:Humans; D009154:Mutation; D015995:Prevalence; D013030:Spain / Q000453:epidemiology
chemical_list: D000998:Antiviral Agents