Time trends in drug resistant HIV-1 infections in the United Kingdom up to 2009: multicentre observational study.
OBJECTIVE
To evaluate whether the prevalence of HIV-1 transmitted drug resistance has continued to decline in infections probably acquired within the United Kingdom.


METHODS
Multicentre observational study.


METHODS
All UK public laboratories conducting tests for genotypic HIV resistance as a part of routine care.


METHODS
14,584 patients infected with HIV-1 subtype B virus, who were first tested for resistance before receiving antiretroviral therapy between January 2002 and December 2009.


METHODS
Prevalence of transmitted drug resistance, defined as one or more resistance mutations from the surveillance list recommended by the World Health Organization.


RESULTS
1654 (11.3%, 95% confidence interval 10.8% to 11.9%) patients had one or more mutations associated with transmitted HIV-1 drug resistance; prevalence was found to decline from 15.5% in 2002 to 9.6% in 2007, followed by a slight increase to 10.9% in 2009 (P=0.21). This later rise was mainly a result of increases in resistance to nucleos(t)ide reverse transcriptase inhibitors (from 5.4% in 2007 to 6.6% in 2009, P=0.24) and protease inhibitors (1.5% to 2.1%, P=0.12). Thymidine analogue mutations, including T215 revertants, remained the most frequent mutations associated with nucleos(t)ide reverse transcriptase inhibitors, despite a considerable fall in stavudine and zidovudine use between 2002 and 2009 (from 29.4% of drug regimens in 2002 to 0.8% in 2009, from 47.9% to 8.8%, respectively).


CONCLUSIONS
The previously observed decline in the prevalence of transmitted drug resistance in HIV-1 infections probably acquired in the UK seems to have stabilised. The continued high prevalence of thymidine analogue mutations suggests that the source of this resistance may be increasingly from patients who have not undergone antiretroviral therapy and who harbour resistant viruses. Testing of all newly diagnosed HIV-1 positive people should be continued.
UK HIV Drug Resistance Database, MRC Clinical Trials Unit, London WC2B 6NH, UK David.dolling@ctu.mrc.ac.uk
David
D
Dolling
Caroline
C
Sabin
Valerie
V
Delpech
Erasmus
E
Smit
Anton
A
Pozniak
David
D
Asboe
Andrew Leigh
AL
Brown
Duncan
D
Churchill
Ian
I
Williams
Anna Maria
AM
Geretti
Andrew
A
Phillips
Nicola
N
Mackie
Gary
G
Murphy
Hannah
H
Castro
Deenan
D
Pillay
Patricia
P
Cane
David
D
Dunn
David
D
Dolling
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D015331:Cohort Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D059645:Mutation Rate; D015995:Prevalence; D006113:United Kingdom / Q000453:epidemiology; D055815:Young Adult
D044966:Anti-Retroviral Agents