title: 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.
abstract: BACKGROUND
  Our study describes the prevalence of transmitted drug resistance (TDR) among 1318 French patients diagnosed at the time of primary HIV-1 infection (PHI) in 2007-12.
  
  
  METHODS
  HIV-1 resistance-associated mutations (RAMs) 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 ART combination.
  
  
  RESULTS
  Patients were mainly MSM (72.6%). Non-B variants were identified in 33.7% of patients. The proportion of TDR was estimated as 11.7% (95% CI 10.0-13.5). The prevalences of PI-, NRTI-, first-generation NNRTI and etravirine/rilpivirine-associated RAMs 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 2010-12 had integrase inhibitor (II)-related RAMs (isolated E157Q mutation in all cases). TDR 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%, ≥97.3% and ≥95.3% in cases of PI-, II- and NNRTI-based regimens, respectively. In 2010-12, the proportion of fully active efavirenz-based ART was lower in cases of subtype B versus non-B infection (P = 0.021).
  
  
  CONCLUSIONS
  Compared with our previous studies, the proportion of NRTI- and first-generation NNRTI-related TDR has continued to decline in French seroconverters. However, subtype B-infected MSM could drive the spread of resistant HIV strains. Finally, we suggest preferring PI- or II- to NNRTI-based combinations to treat PHI patients.
authors.affiliation: Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France EA7327, Université Paris Descartes, Sorbonne Paris Cité, Paris, France pierre.frange@nck.aphp.fr.
authors.forename: Pierre
authors.initials: P
authors.lastname: Frange
authors.affiliation: Sorbonne Universités, UPMC Université Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
authors.forename: Lambert
authors.initials: L
authors.lastname: Assoumou
authors.affiliation: Laboratoire de Virologie, AP-HP, Hôpital Bichat-Claude Bernard, Paris, France INSERM UMR1137 IAME, Université Paris Diderot, F-75018 Paris, France.
authors.forename: Diane
authors.initials: D
authors.lastname: Descamps
authors.affiliation: EA7327, Université Paris Descartes, Sorbonne Paris Cité, Paris, France Service de médecine interne, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Chéret
authors.affiliation: Service de médecine interne, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, France INSERM CESP, U1018, Université Paris Sud, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France.
authors.forename: Cécile
authors.initials: C
authors.lastname: Goujard
authors.affiliation: INSERM CESP, U1018, Université Paris Sud, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France Département d'Epidémiologie, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Laurent
authors.initials: L
authors.lastname: Tran
authors.affiliation: Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France.
authors.forename: Marine
authors.initials: M
authors.lastname: Gousset
authors.affiliation: Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France EA7327, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Veronique
authors.initials: V
authors.lastname: Avettand-Fenoël
authors.affiliation: Laboratoire de Virologie, Centre hospitalo-universitaire de Lille, Lille, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Bocket
authors.affiliation: Laboratoire de Virologie, Hôpitaux Universitaires de Strasbourg, Strasbourg, France INSERM, U1109, LabEx TRANSPLANTEX Fédération de Médecine Translationnelle de Strasbourg, Université de Strasbourg, Strasbourg, France.
authors.forename: Samira
authors.initials: S
authors.lastname: Fafi-Kremer
authors.affiliation: Laboratoire de Microbiologie, Centre hospitalier régional d'Orléans, Orléans, France.
authors.forename: Jerome
authors.initials: J
authors.lastname: Guinard
authors.affiliation: Laboratoire de Virologie, AP-HP, Hôpital Saint Antoine, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Morand-Joubert
authors.affiliation: Laboratoire de Virologie, Institut fédératif de biologie de Purpan, CHU de Toulouse, Hôpital Purpan, F-31300 Toulouse, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Nicot
authors.affiliation: Laboratoire de Virologie et COREVIH Haute Normandie, Centre hospitalo-universitaire Charles Nicolle, Rouen, France.
authors.forename: Jean-Christophe
authors.initials: JC
authors.lastname: Plantier
authors.affiliation: Laboratoire de Virologie, Centre hospitalo-universitaire de Limoges, Limoges, France.
authors.forename: Sylvie
authors.initials: S
authors.lastname: Rogez
authors.affiliation: Laboratoire de Virologie, AP-HP, Groupe hospitalier Pitié-Salpêtrière, Sorbonne Universités, UPMC Univ Paris 06, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique, Paris, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Wirden
authors.affiliation: Laboratoire de Microbiologie, Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpital Necker-Enfants Malades, Paris, France EA7327, Université Paris Descartes, Sorbonne Paris Cité, Paris, France.
authors.forename: Christine
authors.initials: C
authors.lastname: Rouzioux
authors.affiliation: INSERM CESP, U1018, Université Paris Sud, Faculté de Médecine Paris Sud, Le Kremlin Bicêtre, France Département d'Epidémiologie, AP-HP, Hôpital Bicêtre, Le Kremlin Bicêtre, France.
authors.forename: Laurence
authors.initials: L
authors.lastname: Meyer
authors.affiliation: Laboratoire de Virologie, AP-HP, Hôpital Saint Louis, INSERM U941, Université Paris Diderot, Laboratoire associé au Centre national de Référence du VIH, Paris, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Chaix
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology; D018562:Disease Transmission, Infectious; D024882:Drug Resistance, Viral; D005260:Female; D005602:France / Q000453:epidemiology; D005838:Genotype; D060005:Genotyping Techniques; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission*; D015497:HIV-1 / Q000145:classification* / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification*; D018451:Homosexuality, Male; D006801:Humans; D008297:Male; D020125:Mutation, Missense; D015995:Prevalence
chemical_list: D019380:Anti-HIV Agents
keywords: HIV-1; primary HIV infection; resistance-associated mutations