title: Estimating trends in the proportion of transmitted and acquired HIV drug resistance in a long term observational cohort in Germany.
abstract: OBJECTIVE
  We assessed trends in the proportion of transmitted (TDR) and acquired (ADR) HIV drug resistance and associated mutations between 2001 and 2011 in the German ClinSurv-HIV Drug Resistance Study.
  
  
  METHODS
  The German ClinSurv-HIV Drug Resistance Study is a subset of the German ClinSurv-HIV Cohort. For the ClinSurv-HIV Drug Resistance Study all available sequences isolated from patients in five study centres of the long term observational ClinSurv-HIV Cohort were included. TDR was estimated using the first viral sequence of antiretroviral treatment (ART) naïve patients. One HIV sequence/patient/year of ART experienced patients was considered to estimate the proportion of ADR. Trends in the proportion of HIV drug resistance were calculated by logistic regression.
  
  
  RESULTS
  9,528 patients were included into the analysis. HIV-sequences of antiretroviral naïve and treatment experienced patients were available from 34% (3,267/9,528) of patients. The proportion of TDR over time was stable at 10.4% (95% CI 9.1-11.8; p for trend = 0.6; 2001-2011). The proportion of ADR among all treated patients was 16%, whereas it was high among those with available HIV genotypic resistance test (64%; 1,310/2,049 sequences; 95% CI 62-66) but declined significantly over time (OR 0.8; 95% CI 0.77-0.83; p for trend<0.001; 2001-2011). Viral load monitoring subsequent to resistance testing was performed in the majority of treated patients (96%) and most of them (67%) were treated successfully.
  
  
  CONCLUSIONS
  The proportion of TDR was stable in this study population. ADR declined significantly over time. This decline might have been influenced by broader resistance testing, resistance test guided therapy and the availability of more therapeutic options and not by a decline in the proportion of TDR within the study population.
authors.affiliation: Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Schmidt
authors.affiliation: Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kollan
authors.affiliation: Clinic of Internal Medicine, University Köln, Köln, Germany.
authors.forename: Gerd
authors.initials: G
authors.lastname: Fätkenheuer
authors.affiliation: Clinic of Internal Medicine, University Köln, Köln, Germany.
authors.forename: Eugen
authors.initials: E
authors.lastname: Schülter
authors.affiliation: ICH Study Centre, Hamburg, Germany.
authors.forename: Hans-Jürgen
authors.initials: HJ
authors.lastname: Stellbrink
authors.affiliation: Laboratory Lademannbogen, Hamburg, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Noah
authors.affiliation: Department of Gastroenterology, Hepatology and Infectious Diseases, Heinrich Heine University, Düsseldorf, Germany.
authors.forename: Björn-Erik Ole
authors.initials: BE
authors.lastname: Jensen
authors.affiliation: Clinic for Immunology and Rheumatology, Infectious Diseases Unit, Medical University Hannover, Hannover, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Stoll
authors.affiliation: Department of Infectious Disease, Med IV, University Hospital of Munich, Munich Germany.
authors.forename: Johannes R
authors.initials: JR
authors.lastname: Bogner
authors.affiliation: Max von Pettenkofer Institute, Institute of Virology, Ludwig Maximilians University, Munich, Germany.
authors.forename: Josef
authors.initials: J
authors.lastname: Eberle
authors.affiliation: Department of Infectious Diseases, HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany.
authors.forename: Karolin
authors.initials: K
authors.lastname: Meixenberger
authors.affiliation: Department of Infectious Diseases, HIV and Other Retroviruses, Robert Koch Institute, Berlin, Germany.
authors.forename: Claudia
authors.initials: C
authors.lastname: Kücherer
authors.affiliation: Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany.
authors.forename: Osamah
authors.initials: O
authors.lastname: Hamouda
authors.affiliation: Department of Infectious Disease Epidemiology, HIV/AIDS, STI and Blood Born Infections, Robert Koch-Institute, Berlin, Germany.
authors.forename: Barbara
authors.initials: B
authors.lastname: Bartmeyer
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D024882:Drug Resistance, Viral; D005260:Female; D005838:Genotype; D005858:Germany; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics*; D006801:Humans; D008297:Male; D009154:Mutation; D012307:Risk Factors; D019562:Viral Load
chemical_list: D019380:Anti-HIV Agents