Increased Transmitted Drug-Resistance Mutations of Non-B HIV Subtypes

In France, the prevalence of transmitted-drug-resistance-associated mutations remained stable from 2010-2011 to 2015-2016, but there may be an increase in cases of HIV-1 non-B subtypes in patients with HIV who are antiretroviral-naïve in 2015-2016, according to study results published in The Journal of Antimicrobial Chemotherapy.

Although HIV incidence and AIDS mortality have decreased with increased access to HIV antiretroviral therapy (ART), an increase in HIV drug resistance has emerged that may lower the effectiveness of first‑line ART at the population level. Therefore, this study surveyed the prevalence of transmitted-drug-resistance-associated mutations and non-B HIV-1 subtypes in patients with HIV-1 who were antiretroviral-naive in 2015 and 2016.

Using data from 33 HIV clinical centers during 2015 and 2016, 660 individuals diagnosed as HIV positive provided samples for the study of transmitted-drug-resistance-associated mutations. Analyses were used to estimate the percentage of individuals with transmitted-drug-resistance-associated mutations. These results were then compared with the results from a 2010-2011 survey that analyzed 661 samples using the same methodology. The population baseline characteristics between 2010-2011 and 2015-2016 are as follows: CD4 ell count was 394/mm³ and 350/mm³ (P =.056) and plasma HIV-1 RNA was 4.6 log₁₀ and 4.6 log₁₀ (P =.360), respectively.

In 2015-2016, the overall prevalence of transmitted-drug-resistance-associated mutations was 10.8% and stable compared with the previous survey performed in 2010-2011, in which the prevalence of transmitted-drug-resistance-associated mutations was 9.0% (P =.269). This reported prevalence is similar that reported in Europe, the United States, and Canada. However, the prevalence of non-B HIV subtypes significantly increased from 42.9% in 2010-2011 to 54.8% in 2015-2016 (P <.001). A multivariable analysis showed that the group of men infected with the B subtype had the highest risk for harboring virus with drug resistance mutations and the risk for being infected with a resistant virus was 2.2-fold higher compared with men with non-B subtype (adjusted odds ratio, 2.25). Further, men who have sex with men, with B subtype represented 76.5% of the male population in 2010-2011 and 79.8% of the male population in 2015-2016. The prevalence of virus with protease or reverse-transcriptase transmitted-drug-resistance-associated mutations and integrase inhibitor transmitted-drug-resistance-associated mutations was not significantly increased in the 2015-2016 survey from 2010-2011.

Overall, the study authors concluded that, “[T]hese data highlight the importance of genotypic resistance testing at diagnosis and/or before the initiation of ART. These data also support the need to continue the surveillance of [transmitted-drug-resistance-associated mutations] for all classes of antiretroviral drugs worldwide.”

Reference

Assoumou L, Bocket L, Pallier C, et al. Stable prevalence of transmitted drug resistance mutations and increased circulation of non-B subtypes in antiretroviral-naive chronically HIV-infected patients in 2015/2016 in France [published online February 11, 2019]. J Antimicrob Chemother. doi:10.1093/jac/dkz011