Patterns of transmitted HIV drug resistance in Europe vary by risk group.
BACKGROUND
In Europe, a continuous programme (SPREAD) has been in place for ten years to study transmission of drug resistant HIV. We analysed time trends of transmitted drug resistance mutations (TDRM) in relation to the risk behaviour reported.


METHODS
HIV-1 patients newly diagnosed in 27 countries from 2002 through 2007 were included. Inclusion was representative for risk group and geographical distribution in the participating countries in Europe. Trends over time were calculated by logistic regression.


RESULTS
From the 4317 patients included, the majority was men-having-sex-with-men -MSM (2084, 48%), followed by heterosexuals (1501, 35%) and injection drug users (IDU) (355, 8%). MSM were more often from Western Europe origin, infected with subtype B virus, and recently infected (<1 year) (p<0.001). The prevalence of TDRM was highest in MSM (prevalence of 11.1%), followed by heterosexuals (6.6%) and IDU (5.1%, p<0.001). TDRM was predominantly ascribed to nucleoside reverse transcriptase inhibitors (NRTI) with a prevalence of 6.6% in MSM, 3.3% in heterosexuals and 2.0% in IDU (p = 0.001). A significant increase in resistance to non- nucleoside reverse transcriptase inhibitors (NNRTIs) and a decrease in resistance to protease inhibitors was observed in MSM (p = 0.008 and p = 0.006, respectively), but not in heterosexual patients (p = 0.68 and p = 0.14, respectively).


CONCLUSIONS
MSM showed to have significantly higher TDRM prevalence compared to heterosexuals and IDU. The increasing NNRTI resistance in MSM is likely to negatively influence the therapy response of first-line therapy, as most include NNRTI drugs.
Department of virology, Erasmus Medical Center, Rotterdam, the Netherlands.
Dineke
D
Frentz
Department of virology, Erasmus Medical Center, Rotterdam, the Netherlands.
David
D
van de Vijver
Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal.
Ana
A
Abecasis
Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden.
Jan
J
Albert
Robert Koch Institute, Berlin, Germany.
Osamah
O
Hamouda
Statens Serum Institute, Copenhagen, Denmark.
Louise
L
Jørgensen
Robert Koch Institute, Berlin, Germany.
Claudia
C
Kücherer
Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg.
Daniel
D
Struck
Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg; Centre Hospitalier de Luxembourg, Luxembourg.
Jean-Claude
JC
Schmit
Rega Institute, Katholieke Universiteit Leuven, Leuven, Belgium.
Jurgen
J
Vercauteren
Section for Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway.
Birgitta
B
Asjö
University of Milan, Milan, Italy.
Claudia
C
Balotta
Department of GU Medicine & Infectious Diseases, St James's Hospital, Dublin, Ireland.
Colm
C
Bergin
Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
Danail
D
Beshkov
Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal; Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal.
Ricardo
R
Camacho
irsiCaixa AIDS Research Institute & Lluita contra la SIDA Foundation, Hospital Universitari "Germans Trias i Pujol," Badalona, Spain.
Bonaventura
B
Clotet
National Public Health Surveillance Laboratory, Vilnius, Lithuania.
Algirdas
A
Griskevicius
Sheba Medical Center, Tel Hashomer, Israel.
Zehava
Z
Grossman
Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland.
Andrzej
A
Horban
Infectology Center of Latvia, Riga, Latvia.
Tatjana
T
Kolupajeva
University of Erlangen-Nuremberg, Erlangen, Germany.
Klaus
K
Korn
University of Cyprus, Nicosia, Cyprus.
Leondios
L
Kostrikis
National Institute for Health and Welfare, Helsinki, Finland; National Institute of Public Health, Prague, Czech Republic.
Kirsi Liitsola Marek
KL
Linka
Robert Koch Institute, Berlin, Germany.
Claus
C
Nielsen
Molecular Diagnostics, "Prof Dr Matei Bals" Institute for Infectious Diseases, Bucharest, Romania.
Dan
D
Otelea
Medical School, University of Athens, Athens, Greece.
Dimitrios
D
Paraskevis
Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria.
Roger
R
Paredes
University of Ljubljana, Ljubljana, Slovenia.
Mario
M
Poljak
Medical University Vienna, Vienna, Austria.
Elisabeth
E
Puchhammer-Stöckl
Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Divisions of Infectious Diseases and Clinical Virology, Karolinska Institute, Stockholm, Sweden.
Anders
A
Sönnerborg
Slovak Medical University, Bratislava, Slovakia.
Danica
D
Stanekova
University of Belgrade School of Medicine, Belgrade, Serbia.
Maja
M
Stanojevic
Rega Institute, Katholieke Universiteit Leuven, Leuven, Belgium.
Anne-Mieke
AM
Vandamme
Department of virology, Erasmus Medical Center, Rotterdam, the Netherlands.
Charles
C
Boucher
Department of virology, Erasmus Medical Center, Rotterdam, the Netherlands; Centro de Malária e outras Doenças Tropicais, Instituto de Higiene e Medicina Tropical, Universidade Nova de Lisboa, Lisboa, Portugal; Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Microbiology, Karolinska University Hospital, Stockholm, Sweden; Robert Koch Institute, Berlin, Germany; Statens Serum Institute, Copenhagen, Denmark; Laboratory of Retrovirology, CRP-Santé, Luxembourg, Luxembourg; Centre Hospitalier de Luxembourg, Luxembourg; Rega Institute, Katholieke Universiteit Leuven, Leuven, Belgium; Section for Microbiology and Immunology, The Gade Institute, University of Bergen, Bergen, Norway; University of Milan, Milan, Italy; Department of GU Medicine & Infectious Diseases, St James's Hospital, Dublin, Ireland; Department of Virology, National Center of Infectious and Parasitic Diseases, Sofia, Bulgaria; Hospital Egas Moniz, Centro Hospitalar de Lisboa Ocidental, Lisboa, Portugal; irsiCaixa AIDS Research Institute & Lluita contra la SIDA Foundation, Hospital Universitari "Germans Trias i Pujol," Badalona, Spain; National Public Health Surveillance Laboratory, Vilnius, Lithuania; Sheba Medical Center, Tel Hashomer, Israel; Warsaw Medical University and Hospital of Infectious Diseases, Warsaw, Poland; Infectology Center of Latvia, Riga, Latvia; University of Erlangen-Nuremberg, Erlangen, Germany; University of Cyprus, Nicosia, Cyprus; National Institute for Health and Welfare, Helsinki, Finland; National Institute of Public Health, Prague, Czech Republic; Molecular Diagnostics, "Prof Dr Matei Bals" Institute for Infectious Diseases, Bucharest, Romania; Medical School, University of Athens, Athens, Greece; University of Ljubljana, Ljubljana, Slovenia; Medical University Vienna, Vienna, Austria; Divisions of Infectious Diseases and Clinical Virology, Karolinska Institute, Stockholm, Sweden; Slovak Medical University
Annemarie
A
Wensing
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D024882:Drug Resistance, Viral; D005060:Europe / Q000453:epidemiology; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects*; D020010:Heterosexuality / Q000706:statistics & numerical data; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors / Q000627:therapeutic use; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use; D012306:Risk; D012309:Risk-Taking; D012725:Sexual Behavior / Q000706:statistics & numerical data; D015819:Substance Abuse, Intravenous / Q000453:epidemiology / Q000821:virology*
D019380:Anti-HIV Agents; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors