Transmission of HIV Drug Resistance and the Predicted Effect on Current First-line Regimens in Europe

Transmitted human immunodeficiency virus drug resistance in Europe is stable at around 8%. The impact of baseline mutation patterns on susceptibility to antiretroviral drugs should be addressed using clinical guidelines. The impact on baseline susceptibility is largest for nonnucleoside reverse transcriptase inhibitors.

Background. Numerous studies have shown that baseline drug resistance patterns may influence the outcome of antiretroviral therapy. Therefore, guidelines recommend drug resistance testing to guide the choice of initial regimen. In addition to optimizing individual patient management, these baseline resistance data enable transmitted drug resistance (TDR) to be surveyed for public health purposes. The SPREAD program systematically collects data to gain insight into TDR occurring in Europe since 2001.

Methods. Demographic, clinical, and virological data from 4140 antiretroviral-naive human immunodeficiency virus (HIV)–infected individuals from 26 countries who were newly diagnosed between 2008 and 2010 were analyzed. Evidence of TDR was defined using the WHO list for surveillance of drug resistance mutations. Prevalence of TDR was assessed over time by comparing the results to SPREAD data from 2002 to 2007. Baseline susceptibility to antiretroviral drugs was predicted using the Stanford HIVdb program version 7.0.

Results. The overall prevalence of TDR did not change significantly over time and was 8.3% (95% confidence interval, 7.2%–9.5%) in 2008–2010. The most frequent indicators of TDR were nucleoside reverse transcriptase inhibitor (NRTI) mutations (4.5%), followed by nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations (2.9%) and protease inhibitor mutations (2.0%). Baseline mutations were most predictive of reduced susceptibility to initial NNRTI-based regimens: 4.5% and 6.5% of patient isolates were predicted to have resistance to regimens containing efavirenz or rilpivirine, respectively, independent of current NRTI backbones.

Conclusions. Although TDR was highest for NRTIs, the impact of baseline drug resistance patterns on susceptibility was largest for NNRTIs. The prevalence of TDR assessed by epidemiological surveys does not clearly indicate to what degree susceptibility to different drug classes is affected.

[Malaria in Poland in 1999]

In 1999 32 malaria cases were registered in Poland. All of them were imported, mainly from Africa (25). Plasmodium falciparum infection was confirmed in 20 cases. Among 32 malaria cases 26 were men and 26 in 20 to 49 years old group. Ten persons travelled abroad in the connection with their job, nine--as tourist. In 1999 51-year-old man died with myocarditis complicating malaria.

[AIDS and HIV infection in Poland in 1999]

After gradual increasing in the number of annually diagnosed AIDS cases in the last years these numbers remained relatively stable (nearly 120). The biggest number of newly discovered HIV infections (809) was reported in 1990. Next years these numbers ranged from 384 in 1993 to 637 in 1998. Majority of AIDS cases and HIV-infected persons in Poland were drug users, respectively 50% and 60%. Between 1985 and 1999 some important changes have been observed in Polish data collection system concerning for example: anonimity of reported HIV infections, data completeness and reporting of AIDS indicator diseases. Quality of collected epidemiological data will depend--among others things--on: easy access to HIV testing, data completeness and diagnosis of AIDS indicator diseases by definitive methods.

[Malaria in 1998]

In 1998 38 malaria cases were registered in Poland. All of them were imported, mainly from Africa (28), and some from Asia. Plasmodium falciparum infection was confirmed in 19 cases. Among 38 malaria cases 29 were men. The majority of malaria cases (28) were in 20 to 49 year old group. Fourteen persons travelled abroad in the connexion with their job, eleven--as tourists and some--as missionaries. In 1998 malaria deaths were not registered.

[AIDS and HIV infection in 1998]

Last years number of notified and registered AIDS cases was quite stable. Some increasing of HIV infections number was observed. Quality of collected epidemiological data will depend--among other things--on: easy access to HIV testing, completeness of data and diagnosis of AIDS indicator diseases by definitive methods.

[AIDS and HIV infections in 1997]

In Poland 114 AIDS cases and 579 newly discovered HIV infections have been registered in 1997. Annual numbers of diagnosed and notified AIDS cases and HIV infections were rather stable during last years. The nearest future of HIV/AIDS epidemiological situation will depend on medical and social care, personal behaviours and preventive activities.

[Malaria in Poland in 1997]

In 1997 37 malaria cases were registered in Poland. All of them were imported, mainly from Africa (26), and some from Asia. Plasmodium falciparum infection was confirmed in 23 cases. Among 37 malaria cases 31 were men. The majority of malaria cases (27) were in 20 to 49 year old group. Eighteen persons travelled abroad in the connexion with their job (especially as sailors and agropilots) and eleven--as missionaries. Three men (44, 47 and 70 years old) with P. falciparum malaria died.

[Malaria in Poland]

Malaria epidemiological situation in Poland since nineteenth century to 1995 has been described. The changes observed during this period are enormous. Poland has been transformed from endemic country with huge epidemics into the country with sporadic imported malaria cases.