First line treatment response in patients with transmitted HIV drug resistance and well defined time point of HIV infection: updated results from the German HIV-1 seroconverter study

• Published in: PloS one 2014-05, Vol.9 (5), p.e95956-e95956
• Main Authors: Zu Knyphausen, Fabia, Scheufele, Ramona, Kücherer, Claudia, Jansen, Klaus, Somogyi, Sybille, Dupke, Stephan, Jessen, Heiko, Schürmann, Dirk, Hamouda, Osamah, Meixenberger, Karolin, Bartmeyer, Barbara
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Algorithms; Analysis; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral Therapy, Highly Active; Biological products industry; Care and treatment; CD4 Lymphocyte Count; Disease transmission; DNA polymerases; Drug resistance; Drug Resistance, Viral; Epidemiology; Failure; Female; Genotype; Health aspects; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - transmission; HIV Infections - virology; HIV-1 - genetics; Human immunodeficiency virus; Humans; Level (quantity); Male; Medicine and Health Sciences; Mutation; Patients; Prevalence; Protease inhibitors; Proteases; Risk Factors; RNA-directed DNA polymerase; Therapy; Treatment Outcome; Viral Load
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0095956

Transmission of drug-resistant HIV-1 (TDR) can impair the virologic response to antiretroviral combination therapy. Aim of the study was to assess the impact of TDR on treatment success of resistance test-guided first-line therapy in the German HIV-1 Seroconverter Cohort for patients infected with HIV between 1996 and 2010. An update of the prevalence of TDR and trend over time was performed. Data of 1,667 HIV-infected individuals who seroconverted between 1996 and 2010 were analysed. The WHO drug resistance mutations list was used to identify resistance-associated HIV mutations in drug-naïve patients for epidemiological analysis. For treatment success analysis the Stanford algorithm was used to classify a subset of 323 drug-naïve genotyped patients who received a first-line cART into three resistance groups: patients without TDR, patients with TDR and fully active cART and patients with TDR and non-fully active cART. The frequency of virologic failure 5 to 12 months after treatment initiation was determined. Prevalence of TDR was stable at a high mean level of 11.9% (198/1,667) in the HIV-1 Seroconverter Cohort without significant trend over time. Nucleotide reverse transcriptase inhibitor resistance was predominant (6.0%) and decreased significantly over time (OR = 0.92, CI = 0.87-0.98, p = 0.01). Non-nucleoside reverse transcriptase inhibitor (2.4%; OR = 1.00, CI = 0.92-1.09, p = 0.96) and protease inhibitor resistance (2.0%; OR = 0.94, CI = 0.861.03, p = 0.17) remained stable. Virologic failure was observed in 6.5% of patients with TDR receiving fully active cART, 5,6% of patients with TDR receiving non-fully active cART and 3.2% of patients without TDR. The difference between the three groups was not significant (p = 0.41). Overall prevalence of TDR remained stable at a rather high level. No significant differences in the frequency of virologic failure were identified during first-line cART between patients with TDR and fully-active cART, patients with TDR and non-fully active cART and patients without TDR.