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Pinto A, Carrera A, Salem H, Thapa K, Shaik A, Petoumenos K, Cunningham P, Garsia R, Dwyer D, Cooper DA, Kelleher A. Evolution of HIV-1 Surveillance Drug Resistance Mutations Over 10 Years in New South Wales, Australia. AIDS Res Hum Retroviruses 2021; 37:897-902. [PMID: 28474534 DOI: 10.1089/aid.2016.0301] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
New South Wales has the greatest burden of HIV in Australia, with 2012 and 2013 recording the highest rates of new diagnoses in 20 years. Concurrently, there has been significant changes in antiretroviral treatments and testing paradigms. We compiled a statewide resistance database to characterize changes in HIV-1 resistance mutations over time. Genotypic antiretroviral resistance testing (GART) was performed on request at three reference laboratories using commercial and in-house methods. In total, 7629 HIV-1 polymerase sequences obtained from GART from 2004 to 2013 were retrospectively collated, reformatted, de-identified, and analyzed using Stanford HIVdb program 7.0 and the 2009 World Health Organization (WHO) surveillance drug resistance mutations (SDRMs). Analyses were performed on subgroups of known treatment naives, treatment experienced, and seroconverters. There has been a decrease in overall rates of prevalent drug resistance mutations from 57.8% in 2004 to 21% in 2013. Dual and triple class resistance mutations have decreased from 32.7% in 2004 to 5.8% in 2013 and 16.4% to 1.2%, respectively. In treatment-naive individuals (n = 450), the frequency of protease inhibitor (PI) mutations remains low at 2.7%. In seroconverters, rates of transmitted drug resistance (TDR) are 6.6%, 3%, 3%, and 1.5% for overall, PI, non-nucleoside reverse transcription inhibitor (NNRTI), and NRTI, respectively. In treatment experienced, rates remain stable with 36.0%, 18.9%, 29.1%, and 6.4% for overall, NNRTI, NRTI, and PI mutations. The most common mutations in treatment experienced occurred at position M184, T215 (NRTI); K103 (NNRTI); I54 (PI). Apparent decreases in prevalent SDRMs can be attributed to changes in GART testing indications over time. In treatment-naive and -experienced subgroups, rates have been stable with low rates of TDR in seroconverters.
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Affiliation(s)
- Angie Pinto
- Immunovirology and Pathogenesis Program, The Kirby Institute, Randwick, New South Wales, Australia
| | - Alex Carrera
- Department of Immunology, HIV Reference Laboratory, St Vincent's Hospital, Sydney, New South Wales, Australia
| | - Hanan Salem
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Kiran Thapa
- Pathology West, Institute for Clinical Pathology and Medical Research, Sydney, New South Wales, Australia
| | - Ansari Shaik
- Immunovirology and Pathogenesis Program, The Kirby Institute, Randwick, New South Wales, Australia
| | - Kathy Petoumenos
- Immunovirology and Pathogenesis Program, The Kirby Institute, Randwick, New South Wales, Australia
| | - Philip Cunningham
- Virology Research Program, St Vincent's Centre for Applied Medical Research, Sydney, New South Wales, Australia
| | - Roger Garsia
- Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Dominic Dwyer
- Pathology West, Institute for Clinical Pathology and Medical Research, Sydney, New South Wales, Australia
| | - David A. Cooper
- Immunovirology and Pathogenesis Program, The Kirby Institute, Randwick, New South Wales, Australia
| | - Anthony Kelleher
- Immunovirology and Pathogenesis Program, The Kirby Institute, Randwick, New South Wales, Australia
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Pinto AN, Hawke K, Castley A, Chibo D, Giallonardo FD, Cooper C, Sawleshwarkar S, Kelleher A, Dwyer DE. HIV-1 subtype diversity, transmitted drug resistance and phylogenetics in Australia. Future Virol 2018. [DOI: 10.2217/fvl-2018-0031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Australia has maintained a low prevalence of HIV, with a mainly concentrated epidemic and successful public health response. With the widespread availability of HIV genotyping for resistance testing, and development of phylogenetic methodologies, the field of molecular epidemiology has evolved a deeper understanding of diversity and transmission dynamics of HIV. Studies combining HIV genotype with epidemiological data have allowed insights to be gained into the changing subtype diversity, rates of transmitted drug resistance and transmission networks of HIV in Australia. This review provides an overview of HIV molecular epidemiology studies in Australia.
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Affiliation(s)
- Angie N Pinto
- The Kirby Institute, The University of New South Wales, UNSW Sydney, Australia
| | - Karen Hawke
- South Australian Health & Medical Research Institute, Adelaide, South Australia
| | - Allison Castley
- PathWest, Clinical Immunology, Department of Health, Murdoch, Western Australia, Australia
| | - Doris Chibo
- HIV Characterization Laboratory, Victorian Infectious Diseases Reference Laboratory, Doherty Institute, Melbourne, Victoria, Australia
| | | | - Craig Cooper
- Positive Life NSW, Sydney, New South Wales, Australia
| | - Shailendra Sawleshwarkar
- The University of Sydney, Faculty of Medicine & Health, Westmead Clinical School, Western Sydney Sexual Health Centre, Parramatta, New South Wales, Australia
| | - Anthony Kelleher
- The Kirby Institute, The University of New South Wales, UNSW Sydney, Australia
| | - Dominic E Dwyer
- NSWHP-ICPMR, Westmead Hospital, Westmead, NSW, Australia
- Westmead Clinical School, University of Sydney, Westmead, Australia
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Jiamsakul A, Sirivichayakul S, Ditangco R, Wong KH, Li P, Praparattanapan J, Phanuphak P, Segubre-Mercado E, Yam WC, Sirisanthana T, Singtoroj T, Law M. Transmitted drug resistance in recently infected HIV-positive Individuals from four urban locations across Asia (2007-2010) - TASER-S. AIDS Res Ther 2015; 12:3. [PMID: 25685169 PMCID: PMC4326480 DOI: 10.1186/s12981-015-0043-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2014] [Accepted: 02/02/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The availability of HIV antiretroviral therapy (ART) has been associated with the development of transmitted drug resistance-associated mutations (TDRM). TDRM can compromise treatment effectiveness in patients initiating ART and the prevalence can vary in different clinical settings. In this study, we investigated the proportion of TDRM in treatment-naïve, recently infected HIV-positive individuals sampled from four urban locations across Asia between 2007-2010. METHODS Patients enrolled in the TREAT Asia Studies to Evaluate Resistance - Surveillance Study (TASER-S) were genotyped prior to ART initiation, with resulting resistance mutations analysed according to the WHO 2009 list. RESULTS Proportions of TDRM from recently infected individuals from TASER-S ranged from 0% to 8.7% - Hong Kong: 3/88 (3.4%, 95% CI (0.71%-9.64%)); Thailand: Bangkok: 13/277 (4.7%, 95% CI (2.5%-7.9%)), Chiang Mai: 0/17 (0%, 97.5% CI (0%-19.5%)); and the Philippines: 6/69 (8.7%, 95% CI (3.3%-18.0%)). There was no significant increase in TDRM over time across all four clinical settings. CONCLUSIONS The observed proportion of TDRM in TASER-S patients from Hong Kong, Thailand and the Philippines was low to moderate during the study period. Regular monitoring of TDRM should be encouraged, especially with the scale-up of ART at higher CD4 levels.
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Pinto AN, Cooper DA. Antiretroviral therapy: research, rollout and resistance. MICROBIOLOGY AUSTRALIA 2014. [DOI: 10.1071/ma14024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Zaunders J, van Bockel D. Innate and Adaptive Immunity in Long-Term Non-Progression in HIV Disease. Front Immunol 2013; 4:95. [PMID: 23630526 PMCID: PMC3633949 DOI: 10.3389/fimmu.2013.00095] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2013] [Accepted: 04/09/2013] [Indexed: 12/20/2022] Open
Abstract
Long-term non-progressors (LTNP) were identified after 10-15 years of the epidemic, and have been the subject of intense investigation ever since. In a small minority of cases, infection with nef/3'LTR deleted attenuated viral strains allowed control over viral replication. A common feature of LTNP is the readily detected proliferation of CD4 T-cells in vitro, in response to p24. In some cases, the responding CD4 T-cells have cytotoxic effector function and may target conserved p24 epitopes, similar to the CD8 T-cells described below. LTNP may also carry much lower HIV DNA burden in key CD4 subsets, presumably resulting from lower viral replication during primary infection. Some studies, but not others, suggest that LTNP have CD4 T-cells that are relatively resistant to HIV infection in vitro. One possible mechanism may involve up-regulation of the cell cycle regulator p21/waf in CD4 T-cells from LTNP. Delayed progression in Caucasian LTNP is also partly associated with heterozygosity of the Δ32 CCR5 allele, probably through decreased expression of CCR5 co-receptor on CD4 T-cells. However, in approximately half of Caucasian LTNP, two host genotypes, namely HLA-B57 and HLA-B27, are associated with viral control. Immunodominant CD8 T-cells from these individuals target epitopes in p24 that are highly conserved, and escape mutations have significant fitness costs to the virus. Furthermore, recent studies have suggested that these CD8 T-cells from LTNP, but not from HLA-B27 or HLA-B57 progressors, can cross-react with intermediate escape mutations, preventing full escape via compensatory mutations. Humoral immunity appears to play little part in LTNP subjects, since broadly neutralizing antibodies are rare, even amongst slow progressors. Recent genome-wide comparisons between LTNP and progressors have confirmed the HLA-B57, HLA-B27, and delta32 CCR5 allelic associations, plus indicated a role for HLA-C/KIR interactions, but have not revealed any new genotypes so far. Nevertheless, it is hoped that studying the mechanisms of intracellular restriction factors, such as the recently identified SAMHD1, will lead to a better understanding of non-progression.
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Affiliation(s)
- John Zaunders
- Centre for Applied Medical Research, St Vincent's Hospital Darlinghurst, NSW, Australia
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Stekler JD, Ellis GM, Carlsson J, Eilers B, Holte S, Maenza J, Stevens CE, Collier AC, Frenkel LM. Prevalence and impact of minority variant drug resistance mutations in primary HIV-1 infection. PLoS One 2011; 6:e28952. [PMID: 22194957 PMCID: PMC3241703 DOI: 10.1371/journal.pone.0028952] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2011] [Accepted: 11/17/2011] [Indexed: 12/11/2022] Open
Abstract
Objective To evaluate minority variant drug resistance mutations detected by the oligonucleotide ligation assay (OLA) but not consensus sequencing among subjects with primary HIV-1 infection. Design/Methods Observational, longitudinal cohort study. Consensus sequencing and OLA were performed on the first available specimens from 99 subjects enrolled after 1996. Survival analyses, adjusted for HIV-1 RNA levels at the start of antiretroviral (ARV) therapy, evaluated the time to virologic suppression (HIV-1 RNA<50 copies/mL) among subjects with minority variants conferring intermediate or high-level resistance. Results Consensus sequencing and OLA detected resistance mutations in 5% and 27% of subjects, respectively, in specimens obtained a median of 30 days after infection. Median time to virologic suppression was 110 (IQR 62–147) days for 63 treated subjects without detectable mutations, 84 (IQR 56–109) days for ten subjects with minority variant mutations treated with ≥3 active ARVs, and 104 (IQR 60–162) days for nine subjects with minority variant mutations treated with <3 active ARVs (p = .9). Compared to subjects without mutations, time to virologic suppression was similar for subjects with minority variant mutations treated with ≥3 active ARVs (aHR 1.2, 95% CI 0.6–2.4, p = .6) and subjects with minority variant mutations treated with <3 active ARVs (aHR 1.0, 95% CI 0.4–2.4, p = .9). Two subjects with drug resistance and two subjects without detectable resistance experienced virologic failure. Conclusions Consensus sequencing significantly underestimated the prevalence of drug resistance mutations in ARV-naïve subjects with primary HIV-1 infection. Minority variants were not associated with impaired ARV response, possibly due to the small sample size. It is also possible that, with highly-potent ARVs, minority variant mutations may be relevant only at certain critical codons.
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Affiliation(s)
- Joanne D Stekler
- Department of Medicine, University of Washington, Seattle, Washington, United States of America.
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Tong WWY, McAllister J, White PA, Kelleher AD, Carr A. Transmission of triple-class, drug-resistant HIV-1 in Australia. Intern Med J 2010; 40:657-61. [PMID: 20862783 DOI: 10.1111/j.1445-5994.2010.02296.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
We report the first two cases of transmitted triple-class, drug-resistant HIV-1 in Australia. Baseline testing of a newly diagnosed man showed four reverse transcriptase resistance mutations (affecting two drug classes) and six protease resistance mutations. A source patient was identified, and a likely second case newly infected 1 year later, suggesting sequential transmission. This raises therapeutic implications for the individual patients, as well as public health concerns.
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Affiliation(s)
- W W Y Tong
- HIV, Immunology and Infectious Diseases Unit, St Vincent's Hospital, University of New South Wales, Australia.
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Marks AJ, Pillay D, McLean AR. The effect of intrinsic stochasticity on transmitted HIV drug resistance patterns. J Theor Biol 2009; 262:1-13. [PMID: 19766126 DOI: 10.1016/j.jtbi.2009.09.017] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2008] [Revised: 07/29/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
Abstract
Estimates of transmitted HIV drug-resistance prevalence vary widely among and within epidemiological surveys. Interpretation of trends from available survey data is therefore difficult. Because the emergence of drug-resistance involves small populations of infected drug-resistant individuals, the role of stochasticity (chance events) is likely to be important. The question addressed here is: how much variability in transmitted HIV drug-resistance prevalence patterns arises due to intrinsic stochasticity alone, i.e., if all starting conditions in the different epidemics surveyed were identical? This 'thought experiment' gives insight into the minimum expected variabilities within and among epidemics. A simple stochastic mathematical model was implemented. Our results show that stochasticity alone can generate a significant degree of variability and that this depends on the size and variation of the pool of new infections when drug treatment is first introduced. The variability in transmitted drug-resistance prevalence within an epidemic (i.e., the temporal variability) is large when the annual pool of all new infections is small (fewer than 200, typical of the HIV epidemics in Central European and Scandinavian countries) but diminishes rapidly as that pool grows. Epidemiological surveys involving hundreds of new infections annually are therefore needed to allow meaningful interpretation of temporal trends in transmitted drug-resistance prevalence within individual epidemics. The stochastic variability among epidemics shows a similar dependence on the pool of new infections if treatment is introduced after endemic equilibrium is established, but can persist even when there are more than 10,000 new infections annually if drug therapy is introduced earlier. Stochastic models may therefore have an important role to play in interpreting differences in transmitted drug-resistance prevalence trends among epidemiological surveys.
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Guy RJ, McDonald AM, Bartlett MJ, Murray JC, Giele CM, Davey TM, Appuhamy RD, Knibbs P, Coleman D, Hellard ME, Grulich AE, Kaldor JM. HIV diagnoses in Australia: diverging epidemics within a low‐prevalence country. Med J Aust 2007; 187:437-40. [DOI: 10.5694/j.1326-5377.2007.tb01353.x] [Citation(s) in RCA: 52] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2007] [Accepted: 07/09/2007] [Indexed: 11/17/2022]
Affiliation(s)
- Rebecca J Guy
- Centre for Epidemiology and Population Health Research, Burnet Institute, Melbourne, VIC
- Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, VIC
| | - Ann M McDonald
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW
| | - Mark J Bartlett
- Communicable Diseases Branch, NSW Health Department, Sydney, NSW
| | - Jo C Murray
- AIDS Medical Unit, Queensland Health, Brisbane, QLD
| | - Carolien M Giele
- Epidemiology and Surveillance Program, Communicable Disease Control Directorate, Department of Health, Perth, WA
| | | | | | - Peter Knibbs
- Sexual Health and Blood Borne Viruses Unit, Centre for Disease Control, Darwin, NT
| | - David Coleman
- Communicable Diseases Prevention Unit, Department of Health and Human Services, Hobart, TAS
| | - Margaret E Hellard
- Centre for Epidemiology and Population Health Research, Burnet Institute, Melbourne, VIC
| | - Andrew E Grulich
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW
| | - John M Kaldor
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW
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Lindström A, Ohlis A, Huigen M, Nijhuis M, Berglund T, Bratt G, Sandström E, Albert J. HIV-1 Transmission Cluster with M41L ‘Singleton’ Mutation and Decreased Transmission of Resistance in Newly Diagnosed Swedish Homosexual Men. Antivir Ther 2006. [DOI: 10.1177/135965350601100807] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective To investigate the prevalence of HIV-1 with major drug resistance-associated mutations among 261 men who have sex with men (MSM) who were newly diagnosed as HIV-1-infected at Venhälsan, Stockholm, between 1992–2002. Methods Major resistance-associated mutations were identified using an in-house method on stored plasma samples collected within 6 months of diagnosis. Additional samples were investigated from selected patients. Phylogenetic tree analyses were used to study evolutionary relationships between the viruses. Epidemiological data were retrieved from the partner notification investigations and the medical records. Results Informed consent as well as results from the resistance test were available for 201 out of 261 patients (77%) diagnosed during 1992–2002. Viruses from 28 of these 201 patients (14%) displayed major resistance-associated mutations; 27 of these viruses displayed only zidovudine/stavudine resistance-associated mutations. None of the patients displayed resistance mutations to protease inhibitors. The prevalence of resistance-associated mutations decreased over time; 20% in 1992–1996 versus 9% in 1997–2002 ( P=0.04). A transmission cluster involving six patients with a singleton M41L mutation was identified. These viruses were phenotypically sensitive to zidovudine and stavudine. The M41L mutation, as well as most other resistance mutations, was stable for many years after transmission and may have been fixated by other putative compensatory mutations. Conclusions In this Swedish population of MSM with newly diagnosed HIV-1 infection, the prevalence of resistance-associated mutations decreased over time. Reversion of resistance-associated mutations following transmission was slow and incomplete. A large transmission cluster with an interesting M41L singleton mutation was also observed.
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Affiliation(s)
- Anna Lindström
- Department of Virology, Immunology and Vaccinology, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
| | - Anna Ohlis
- Venhälsan, Söder Hospital, Stockholm, Sweden
| | - Marleen Huigen
- Eijkman-Winkler Center, Department of Virology, University Medical Center, Utrecht, The Netherlands
| | - Monique Nijhuis
- Eijkman-Winkler Center, Department of Virology, University Medical Center, Utrecht, The Netherlands
| | - Torsten Berglund
- Department of Epidemiology, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Solna, Sweden
| | - Göran Bratt
- Venhälsan, Söder Hospital, Stockholm, Sweden
| | | | - Jan Albert
- Department of Virology, Immunology and Vaccinology, Swedish Institute for Infectious Disease Control, Solna, Sweden
- Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden
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Shet A, Berry L, Mohri H, Mehandru S, Chung C, Kim A, Jean-Pierre P, Hogan C, Simon V, Boden D, Markowitz M. Tracking the prevalence of transmitted antiretroviral drug-resistant HIV-1: a decade of experience. J Acquir Immune Defic Syndr 2006; 41:439-46. [PMID: 16652051 DOI: 10.1097/01.qai.0000219290.49152.6a] [Citation(s) in RCA: 145] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Transmitted resistance to antiretroviral drugs in acute and early HIV-1 infection has been well documented, although overall trends vary depending on geography and cohort characteristics. To describe the changing pattern of transmitted drug-resistant HIV-1 in a well-defined cohort in New York City, a total of 361 patients with acute or recent HIV-1 infection were prospectively studied over a decade (1995-2004) with respect to HIV-1 genotypes and longitudinal T-cell subsets and HIV-1 RNA levels. The prevalence of overall transmitted resistance changed from 13.2% to 24.1% (P = 0.11) during the periods 1995 to 1998 and 2003 to 2004. Nonnucleoside reverse transcriptase inhibitor resistance prevalence increased significantly from 2.6% to 13.4% (P = 0.007) during the same periods, whereas prevalence of multidrug-resistant virus shifted from 2.6% to 9.8% (P = 0.07) but did not achieve statistical significance. A comparable immunologic and virologic response of appropriately treated individuals was observed regardless of viral drug susceptibility status, suggesting that initial combination therapy guided by baseline resistance testing in the case of acute and early infection may result in a favorable treatment response even in the case of a drug-resistant virus. These data have important implications for selection of empiric first-line regimens for treatment of acutely infected antiretroviral-naive individuals and reinforce the need for baseline resistance testing in acute and early HIV-1 infection.
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Affiliation(s)
- Anita Shet
- Aaron Diamond AIDS Research Center (an affiliate of the Rockefeller University), New York, NY 10016, USA
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Abstract
Observed declines in drug resistance to nucleoside reverse transcriptase inhibitors among persons recently infected with HIV-1 in monitored subpopulations can be interpreted as a positive sign and lead public health officials to decrease efforts towards HIV prevention. By means of a mathematical model, we identified 3 processes that can account for the observed decline: increase in high-risk behavior, decrease in proportion of acutely infected persons whose conditions are treated, and change in treatment efficacy. These processes, singly or in combination, can lead to increases or decreases in disease and drug-resistance prevalence in the general population. We discuss the most appropriate public health response under each scenario and emphasize how further data collection and analyses are required to more reliably evaluate the observed time trends and the relative importance of forces shaping the epidemic. Our study highlights how drug resistance markers can be used as epidemiologic sentinels to devise public health solutions.
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Bezemer D, de Ronde A, Prins M, Porter K, Gifford R, Pillay D, Masquelier B, Fleury H, Dabis F, Back N, Jurriaans S, van der Hoek L, Babiker A, Bhaskaran K, Darbyshire J, Porter K, Walker AS, Gifford R, Pillay D, Balestre E, Capdepont S, Chê G, Dabis F, Hervé F, Masquelier B, Thiébaut R, Hamouda O, Kücherer C, Poggensee G, Balotta C, Longo B, Rezza G, Deho L, Rodriguez C, Soriano V, García-Saiz A, del Romero J, Ortiz M, de Mendoza C, Back N, Coutinho R, Prins M, van der Hoek L, Jørgensen LB, Nielsen C, Pedersen C, Babiker A, Darbyshire JH, Gill N, Johnson AM, Phillips AN, Porter K, Gill MJ, Gingues S. Evolution of Transmitted HIV-1 with Drug-Resistance Mutations in the Absence of Therapy: Effects on Cd4 + T-Cell Count and HIV-1 Rna Load. Antivir Ther 2006. [DOI: 10.1177/135965350601100208] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Sequence analysis of HIV-1 from 440 therapy-naive individuals included within the CASCADE study, who seroconverted within 18 months of the last negative test, identified 65 persons infected with a strain carrying resistance-associated mutations. Population-based sequencing was performed for 20 of these individuals during the therapy-free follow-up period. The median time of follow-up was 15 months (interquartile range from 10 to 23 months). Of these individuals, 12 showed subsequent evolution at the resistance positions, whereas the virus of 8 people was stable during this period. In the reverse transcriptase (RT) gene, the drug-resistant 215Y or 215F codons evolved to alternative codons in all six cases, 70R reverted to the wild-type 70K in 3 of the 4 individuals, 67N evolved only in 1 of 4 patients to a wild-type 67D, 215S evolved to wild-type 215T in 1 of 3 patients, 219N evolved to 219K in 1 of 2 patients, and one patient with 184V reversed to the wild-type 184M. The 181C variant evolved to the wild-type 181Y in 1 of 2 individuals. These codon changes were caused by single nucleotide mutations. No evolution was observed for other RT mutations: 41L, 69D, 69N, 190S, 210W, 215L, 215C, 215E and 219Q. In the protease gene, resistance mutations 84V and 90M were stable in 2 individuals. Comparing the CD4+ T-cell count of the 12 evolving versus the 8 stable cases revealed no statistically significant difference at the date of the first sequence following seroconversion. Interestingly, a lower CD4+ T-cell count was observed in the group without evolution at the second sequence time point ( P=0.043). No difference in HIV-1 RNA load was observed. These results, together with the apparent pressure to mutate at the resistance-associated positions exemplify the decreased fitness of viruses carrying 215Y/F, 70R or 184V
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Affiliation(s)
- Daniela Bezemer
- Municipal Health Service, Amsterdam, the Netherlands
- Population Biology Section, University of Amsterdam, the Netherlands
| | - Anthony de Ronde
- Department of Human Retrovirology, Academic Medical Centre, University of Amsterdam, the Netherlands
| | - Maria Prins
- Municipal Health Service, Amsterdam, the Netherlands
- Department of Human Retrovirology, Academic Medical Centre, University of Amsterdam, the Netherlands
| | | | | | | | - Bernard Masquelier
- Département de Virologie et Immunologie biologique, CHU Bordeaux, France
| | - Hervé Fleury
- Département de Virologie et Immunologie biologique, CHU Bordeaux, France
| | | | - Nicole Back
- Department of Human Retrovirology, Academic Medical Centre, University of Amsterdam, the Netherlands
| | - Suzanne Jurriaans
- Department of Human Retrovirology, Academic Medical Centre, University of Amsterdam, the Netherlands
| | - Lia van der Hoek
- Department of Human Retrovirology, Academic Medical Centre, University of Amsterdam, the Netherlands
| | | | | | | | | | | | - Rob Gifford
- Royal Free & University College Medical School Windeyer Institute
| | - Deenan Pillay
- Royal Free & University College Medical School Windeyer Institute
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- Amsterdam Cohort Studies among homosexual men and drug users, the Netherlands
| | - Nicole Back
- Amsterdam Cohort Studies among homosexual men and drug users, the Netherlands
| | - Roel Coutinho
- Amsterdam Cohort Studies among homosexual men and drug users, the Netherlands
| | - Maria Prins
- Amsterdam Cohort Studies among homosexual men and drug users, the Netherlands
| | - Lia van der Hoek
- Amsterdam Cohort Studies among homosexual men and drug users, the Netherlands
| | | | | | | | | | | | - Noël Gill
- UK Register of HIV Seroconverters, United Kingdom
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Cane P, Chrystie I, Dunn D, Evans B, Geretti AM, Green H, Phillips A, Pillay D, Porter K, Pozniak A, Sabin C, Smit E, Weber J, Zuckerman M. Time trends in primary resistance to HIV drugs in the United Kingdom: multicentre observational study. BMJ 2005; 331:1368. [PMID: 16299012 PMCID: PMC1309643 DOI: 10.1136/bmj.38665.534595.55] [Citation(s) in RCA: 149] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To examine whether the level of primary resistance to HIV drugs is increasing in the United Kingdom. DESIGN Multicentre observational study. SETTING All virology laboratories in the United Kingdom carrying out tests for HIV resistance as part of routine clinical care. PARTICIPANTS 2357 people infected with HIV who were tested for resistance before receiving antiretroviral therapy. MAIN OUTCOME MEASURE Prevalence of drug resistance on basis of the Stanford genotypic interpretation system. RESULTS Over the study period (February 1996 to May 2003), 335 (14.2%, 95% confidence interval 12.8% to 15.7%) samples had mutations that conferred resistance to one or more antiretroviral drugs (9.3% high level resistance, 5.9% medium level resistance). The prevalence of primary resistance has increased markedly over time, although patterns are specific to drug class; the largest increase was for non-nucleoside reverse transcriptase inhibitors. In 2002-3, the prevalence of resistance to any antiretroviral drug to nucleoside or nucleotide reverse transcriptase inhibitors, to non-nucleoside reverse transcriptase inhibitors, or to protease inhibitors was 19.2% (15.7% to 23.2%), 12.4% (9.5% to 15.9%), 8.1% (5.8% to 11.1%), and 6.6% (4.4% to 9.3%), respectively. The risk of primary resistance was only weakly related to most demographic and clinical factors, including ethnicity and viral subtype. CONCLUSIONS The United Kingdom has one of the highest reported rates of primary resistance to HIV drugs worldwide. Prevalence seems still to be increasing and is high in all demographic subgroups.
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Blower S, Bodine E, Kahn J, McFarland W. The antiretroviral rollout and drug-resistant HIV in Africa: insights from empirical data and theoretical models. AIDS 2005; 19:1-14. [PMID: 15627028 DOI: 10.1097/00002030-200501030-00001] [Citation(s) in RCA: 105] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The U.S. Government has pledged to spend $15 billion in Africa and the Caribbean on AIDS. A central focus of this plan is to provide antiretroviral treatment (ART) to millions. Here, we evaluate whether the plan to rollout ART in Africa is likely to generate an epidemic of drug-resistant strains of HIV. We review what has occurred as a result of high usage of ART in developed countries in terms of changes in risky behavior, and the emergence and transmission of drug-resistant HIV. We also review how mathematical models have been used to predict the evolution of drug-resistant HIV epidemics. We then show how models can be used to predict the likely impact of the ART rollout on the evolution of drug-resistant HIV in Africa. At currently planned levels of treatment coverage, we predict that (over the next decade) in Africa: (i) the impact of ART on reducing HIV transmission (and prevalence) is likely to be undetectable (unless accompanied by substantial changes in behavior), (ii) the transmission rate of drug-resistant HIV will be below the WHO surveillance threshold of 5%, and (ii) the majority of cases of drug-resistant HIV that will occur will be due to acquired (and not transmitted) resistance. For the next decade, large-scale surveillance for detecting transmitted resistance in Africa is unnecessary. Instead, we recommend that patients should be closely monitored for acquired resistance, and sentinel surveillance (in a few urban centers) should be used to monitor transmitted resistance.
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Turner D, Brenner B, Routy JP, Moisi D, Rosberger Z, Roger M, Wainberg MA. Diminished Representation of HIV-1 Variants Containing Select Drug Resistance-Conferring Mutations in Primary HIV-1 Infection. J Acquir Immune Defic Syndr 2004; 37:1627-31. [PMID: 15577421 DOI: 10.1097/00126334-200412150-00017] [Citation(s) in RCA: 47] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
This study compared the incidence of HIV-1 variants harboring mutations conferring resistance to thymidine analogues, ie, thymidine analogue mutations (TAMs), nonnucleoside reverse transcriptase (RT) inhibitors (NNMs), lamivudine (3TC) (ie, M184V), and protease inhibitors (PIs) acquired in primary HIV infection (PHI) (n = 59) to their observed prevalence in a corresponding potential transmitter (PT) population of persons harboring resistant infections (n = 380). Both of these populations in the context of this cohort analysis possessed similar demographics. Whereas the frequencies of observed TAMs, NNMs, M184V, and protease-associated mutations (PRAMs) were similar in the PT groups, the prevalence of M184V and major PI mutations were significantly lower in the PHI group (PHI/PT ratios of 0.14 and 0.39, respectively). There was a decreased prevalence in the PHI population of resistant viruses co-expressing NNMs or TAMs with M184V compared with viruses that harbored NNMs or TAMs in the absence of M184V (P < 0.0001). It was also observed that individuals in the PT subgroups who harbored RT mutations or PRAMs with M184V had lower levels of plasma viremia than individuals who lacked M184V (P < 0.05). These findings suggest that both decreased viremia and viral fitness in the case of M184V-containing HIV-1 variants may impact on viral transmissibility.
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Affiliation(s)
- Dan Turner
- McGill University AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, Quebec, Canada
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Routy JP, Machouf N, Edwardes MD, Brenner BG, Thomas R, Trottier B, Rouleau D, Tremblay CL, Côté P, Baril JG, Remis RS, Sékaly RP, Wainberg MA. Factors associated with a decrease in the prevalence of drug resistance in newly HIV-1 infected individuals in Montreal. AIDS 2004; 18:2305-12. [PMID: 15577543 DOI: 10.1097/00002030-200411190-00011] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE A decrease in the prevalence of drug resistance (DR) has been observed among recently infected (RI) individuals in Montreal. A study of chronically infected (CI) patients, who represent potential HIV-1 transmitters, was carried out in order to ascertain biological factors associated with this trend change. DESIGN AND METHODS Retrospective analysis of CI patients was performed for the period 1996-2003. Changes in mean viral load and DR prevalence were assessed in CI patients (n = 2328) and compared to those in RI patients (n = 180) living in the same geographic area. RESULTS A decrease was observed in the prevalence of DR among RI patients, from 13.0% in 1997-2000 to 4.0% in 2001-2003 (P = 0.04). From 1996 to 2000, the mean viral load in the CI patients decreased by 1.34 log10, to remain steady thereafter. The proportion of CI patients who interrupt treatment increased steadily over 1997-2003 from 3.1% to 16.5% (P < 0.0001). Since 1999, when genotyping analysis became available, we have observed a 0.9 log10 decrease in mean viral load among 602 genotyped CI patients harbouring any major mutations. CONCLUSION The decrease in transmission of DR documented in Montreal since 2000 coincides with the drop in mean viral load observed in CI patients. Factors that contribute to the decrease in viral load include routine access to genotyping and availability of more potent antiretroviral drugs. Plasma viral load seems to represent the main predictor for the transmission of DR.
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Affiliation(s)
- Jean-Pierre Routy
- Immunodeficiency Service and Division of Hematology, McGill University Health Centre, McGill University, Montreal, Quebec, Canada.
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Roudinskii NI, Sukhanova AL, Kazennova EV, Weber JN, Pokrovsky VV, Mikhailovich VM, Bobkov AF. Diversity of human immunodeficiency virus type 1 subtype A and CRF03_AB protease in Eastern Europe: selection of the V77I variant and its rapid spread in injecting drug user populations. J Virol 2004; 78:11276-87. [PMID: 15452247 PMCID: PMC521816 DOI: 10.1128/jvi.78.20.11276-11287.2004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
To characterize polymorphisms of the subtype A protease in the former Soviet Union, proviral DNA samples were obtained, with informed consent, from 119 human immunodeficiency virus type 1 (HIV-1)-positive untreated injecting drug users (IDUs) from 16 regions. All individuals studied have never been treated with antiretroviral drugs. The isolates were defined as IDU-A (n = 115) and CRF03_AB (n = 4) by using gag/env HMA/sequencing. The pro region was analyzed by using sequencing and original HIV-ProteaseChip hybridization technology. The mean of pairwise nucleotide distance between 27 pro sequences (23 IDU-A and 4 CRF03_AB) was low (1.38 +/- 0.79; range, 0.00 to 3.23). All sequences contained no primary resistance mutations. However, 13 of 23 (56.5%) subtype A isolates bore the V77I substitution known as the secondary protease mutation. V77I was associated with two synonymous substitutions in triplets 31 and 78, suggesting that all V77I-bearing viruses evolved from a single source in 1997. Hybridization analysis showed that 55 of 115 (47.8%) HIV-1 isolates contained V77I, but this variant was not found in any of 31 DNA samples taken from regions, where the HIV-1 epidemic among IDUs started earlier 1997, as well as in any of four CRF03_AB isolates. The results of analysis of 12 additional samples derived from epidemiologically linked subjects showed that in all four epidemiological clusters the genotype of the donor and the recipients was the same irrespective of the route of transmission. This finding demonstrates the transmission of the V77I mutant variant, which is spreading rapidly within the circulating viral pool in Russia and Kazakhstan. The continued molecular epidemiological and virological monitoring of HIV-1 worldwide thus remains of great importance.
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Affiliation(s)
- Nikita I Roudinskii
- Laboratory of T-Lymphotropic Viruses, D. I. Ivanovsky Institute of Virology, 16 Gamaleya Street, Moscow 123098, Russia
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Vandamme AM, Sönnerborg A, Ait-Khaled M, Albert J, Asjo B, Bacheler L, Banhegyi D, Boucher C, Brun-Vézinet F, Camacho R, Clevenbergh P, Clumeck N, Dedes N, Luca AD, Doerr HW, Faudon JL, Gatti G, Gerstoft J, Hall WW, Hatzakis A, Hellmann N, Horban A, Lundgren JD, Kempf D, Miller M, Miller V, Myers TW, Nielsen C, Opravil M, Palmisano L, Perno CF, Phillips A, Pillay D, Pumarola T, Ruiz L, Salminen M, Schapiro J, Schmidt B, Schmit JC, Schuurman R, Shulse E, Soriano V, Staszewski S, Vella S, Youle M, Ziermann R, Perrin L. Updated European Recommendations for the Clinical Use of HIV Drug Resistance Testing. Antivir Ther 2004. [DOI: 10.1177/135965350400900619] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
In most European countries, HIV drug resistance testing has become a routine clinical tool. However, its practical implementation in a clinical context is demanding. The European HIV Drug Resistance Panel was established to make recommendations to clinicians and virologists on this topic and to propose quality control measures. The panel recommends resistance testing for the following indications: i) drug-naive patients with acute or recent infection; ii) therapy failure, including suboptimal treatment response, when treatment change is considered; iii) pregnant HIV-1-infected women and paediatric patients with detectable viral load when treatment initiation or change is considered; and iv) genotype source patient when post-exposure prophylaxis is considered. In addition, for drug-naive patients with chronic infection in whom treatment is to be started, the panel suggests that resistance testing should be strongly considered and recommends testing the earliest sample for drug resistance if suspicion of resistance is high or prevalence of resistance in this population exceeds 10%. The panel does not favour genotyping over phenotype, however it is anticipated that genotyping will be used more often because of its greater accessibility, lower cost and faster turnaround time. For the interpretation of resistance data, clinically validated systems should be used to the greatest extent possible. It is mandatory that laboratories performing HIV resistance tests take regular part in quality assurance programs. Similarly, it is necessary that HIV clinicians and virologists take part in continuous education and meet regularly to discuss problematic clinical cases. Indeed, resistance test results should be used in the context of all other clinically relevant information for predicting therapy response. The panel also encourages the timely collection of epidemiological information to estimate the impact of transmission of resistant HIV and the prevalence of HIV-1 non-B subtypes in the different European countries.
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Affiliation(s)
- A-M Vandamme
- Rega Institute for Medical Research, Katholieke Universiteit Leuven, Leuven, Belgium
| | - A Sönnerborg
- Divisions of Infectious Diseases and Clinical Virology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden
| | - M Ait-Khaled
- GlaxoSmithKline, HIV Medicines Development Centre Europe, Greenford, UK
| | - J Albert
- Dept of Virology, Swedish Institute for Infectious Diease Control and Microbiology and Tumourbiology Center, Karolinska Institutet, Solna, Sweden
| | - B Asjo
- Centre for Research in Virology, Gade Institute, University of Bergen, Bergen, Norway
| | | | - D Banhegyi
- 5th Department of Medicine, Saint Laszlo Hospital, Budapest, Hungary
| | - C Boucher
- University Medical Centre Utrecht, Utrecht, The Netherlands
| | - F Brun-Vézinet
- Department of Virology, Hôpital Bichat Claude Bernard, Paris, France
| | - R Camacho
- Hospital Egas Moniz, Serviço de Imuno-Hemoterapia, Lisboa, Portugal
| | - P Clevenbergh
- Service de Médecine Interne A, Hôpital Lariboisiere, Paris, France
| | - N Clumeck
- Department of Infectious Diseases, CHU Saint-Pierre, Brussels, Belgium
| | | | - A De Luca
- Istituto di Clinica delle Malattie Infettive, Università Cattolica del Sacro Cuore, Rome, Italy
| | - HW Doerr
- Institute for Medical Virology, University Clinic Frankfurt, Frankfurt, Germany
| | | | - G Gatti
- Vertex Pharmaceuticals, Genova, Italy
| | - J Gerstoft
- Rigshospitalet Department of Infectious Diseases, University of Copenhagen, Copenhagen, Denmark
| | - WW Hall
- University College Dublin, Department Medical Microbiology, Dublin, Ireland
| | - A Hatzakis
- National Retrovirus Reference Centre, Department of Hygiene and Epidemiology, Athens University Medical School, Athens, Greece
| | - N Hellmann
- ViroLogic, Inc., South San Francisco, Calif., USA
| | - A Horban
- Hospital of Infectious Diseases, AIDS Diagnosis and Therapy Centre, Warsaw, Poland
| | - JD Lundgren
- Copenhagen HIV Programme (CHIP) - Section 044, Hvidovre University Hospital, Hvidovre, Denmark
| | - D Kempf
- Abbott Laboratories, Abbott Park, Ill., USA
| | - M Miller
- Gilead Sciences, Foster City, Calif., USA
| | - V Miller
- Forum for Collaborative HIV Research, George Washington University, Washington DC, USA
| | - TW Myers
- Roche Molecular Systems, Alameda, Calif., USA
| | - C Nielsen
- Department of Virology, Statens Serum Institut, Copenhagen S, Denmark
| | - M Opravil
- Department of Medicine, University Hospital Zurich, Zurich, Switzerland
| | | | - CF Perno
- University of Rome Tor Vergata and INMI L. Spallanzani, Rome, Italy
| | - A Phillips
- Royal Free Centre for HIV Medicine and Department of Primary Care & Population Sciences, Royal Free and University College Medical School, London, UK
| | - D Pillay
- Royal Free and University College Medical School, University College London, London, UK
| | - T Pumarola
- Servicio de Microbiología, Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - L Ruiz
- Retrovirology Lab, IRSICAIXA Foundation, Barcelona, Spain
| | - M Salminen
- Department of Infectious Disease Epidemiology, National Public Health Institute, Helsinki, Finland
| | | | - B Schmidt
- Institute of Clinical and Molecular Virology, German National Reference Centre for Retroviruses, Erlangen, Germany
| | - J-C Schmit
- National Service of Infectious Diseases, Retrovirology Laboratory Luxembourg, Centre Hospitalier de Luxembourg, Luxembourg
| | - R Schuurman
- University Medical Centre Utrecht, Department of Virology, Utrecht, The Netherlands
| | - E Shulse
- Celera Diagnostics, Alameda, Calif., USA
| | - V Soriano
- Department of Infectious Diseases, Instituto de Salud Carlos III, Madrid, Spain
| | | | - S Vella
- Istituto Superiore di Sanità, Rome, Italy
| | - M Youle
- Royal Free and University College Medical School, London, UK
| | - R Ziermann
- Bayer HealthCare – Diagnostics, Medical and Scientific Affairs, Berkeley, Calif., USA
| | - L Perrin
- Laboratoire de Virologie, Geneva University Hospital, Geneva, Switzerland
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Bezemer D, Jurriaans S, Prins M, van der Hoek L, Prins JM, de Wolf F, Berkhout B, Coutinho R, Back NKT. Declining trend in transmission of drug-resistant HIV-1 in Amsterdam. AIDS 2004; 18:1571-7. [PMID: 15238775 DOI: 10.1097/01.aids.0000131357.52457.33] [Citation(s) in RCA: 51] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Symptomatic primary HIV infections are over-represented in the mainly hospital-based studies on transmission of resistant HIV-1. We examined a more general population for the prevalence of resistant HIV-1 strains among primary infections. DESIGN From 1994 to 2002 primary infections were identified within the Amsterdam Cohort Studies (ACS) among homosexual men and drug users, and at the Academic Medical Center (AMC). Whereas primary HIV-1-infected AMC patients, often presented with symptoms of acute retroviral syndrome, ACS participants largely seroconverted during follow-up and thus brought also asymptomatic primary infections to our study. METHODS Reverse transcriptase (RT) and protease sequences were obtained by population-based nucleotide sequence analysis of the first HIV RNA-positive sample available. Subtypes were identified by phylogenetic analysis. Mutations were identified based on the IAS-USA resistance table. RESULTS A total of 100 primary HIV-1 infections were identified (32 AMC and 68 ACS). Transmission of drug-resistant strains decreased over calendar time, with 20% [95% confidence interval (CI), 10-34%] of infections bearing drug-resistant mutations before 1998 versus only 6% (95% CI, 1-17%) after 1998. No multi-drug resistance pattern was observed. The median plasma HIV-1 RNA level of the first RNA positive sample was significantly lower for the individuals infected with a resistant strain versus those infected with wild-type, suggesting a fitness-cost to resistance. Four of seven non-B subtypes corresponded with the prevalent subtype in the presumed country of infection, and none showed resistance mutations. CONCLUSIONS The transmission of drug-resistant HIV-1 strains in Amsterdam has decreased over time. Monitoring should be continued as this trend might change.
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Violin M, Velleca R, Cozzi-Lepri A, Riva C, Grossi PA, Carnevale G, Rizzardini G, Petrelli E, Perno CF, Monforte AD, Balotta C. Prevalence of HIV-1 Primary Drug Resistance in Seroconverters of the ICoNA Cohort Over the Period 1996???2001. J Acquir Immune Defic Syndr 2004; 36:761-4. [PMID: 15167299 DOI: 10.1097/00126334-200406010-00017] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Turner D, Schapiro JM, Brenner BG, Wainberg MA. The Influence of Protease Inhibitor Resistance Profiles on Selection of HIV Therapy in Treatment-Naive Patients. Antivir Ther 2004. [DOI: 10.1177/135965350400900308] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Although protease inhibitors (PIs) have dramatically improved outcomes in HIV-infected patients, half still fail treatment with PI-based combination therapy. Genetic pressure from incomplete viral suppression rapidly selects for HIV variants with protease gene mutations that confer reduced susceptibility to PI drugs. A number of specific amino acid substitutions have been associated with PI resistance. However, high-level resistance to individual PIs requires the accumulation of several primary and secondary mutations, developing along drug-specific, step-wise pathways. HIV variants resistant to saquinavir and ritonavir usually contain L90M and V82A substitutions, respectively. Indinavir resistance may be linked to substitutions at positions 46 or 82. Resistance to nelfinavir is primarily associated with D30N but may alternatively be found with L90M. Resistance during exposure to amprenavir can follow development of I50V, which also may confer resistance to lopinavir. Failure during treatment with atazanavir is closely linked to I50L. The overlapping of these pathways can lead to multiple-PI resistance, limiting therapeutic options in antiretroviral-experienced patients. Reduced susceptibility to more than one PI is most likely to be associated with amino acid substitutions at six positions: 10, 46, 54, 82, 84 and 90. Other mutations (D30N, G48V, I50V or I50L) are relatively specific for particular PIs and are less likely to produce cross resistance. Certain resistance mutations selected by exposure to one PI may actually increase susceptibility to others. Patients newly diagnosed with HIV infection are increasingly found to harbour virus that is resistant to the more commonly used drugs. Newer PIs may select for mutations that result in less cross resistance with older agents.
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Affiliation(s)
- Dan Turner
- McGill University AIDS Center, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Jonathan M Schapiro
- Division of Infectious Diseases, Stanford University School of Medicine, Palo Alto, Calif., USA, and Tel-Hashomer Hospital, Ramat-Gan, Israel
| | - Bluma G Brenner
- McGill University AIDS Center, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
| | - Mark A Wainberg
- McGill University AIDS Center, Lady Davis Institute, Jewish General Hospital, Montreal, Canada
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