Prevalence of people living with multidrug‐resistant HIV and limited treatment options in Spain

• Published in: HIV medicine 2024-08, Vol.25 (8), p.946-957
• Main Authors: Llibre, Josep M., García, Federico, Blanco, José Luis, Peláez, Esmeralda Palmier, Cea, Álvaro Mena, Cortés, Luis López, Alonso, Marta Montero, Bernáldez, Miguel Pascual, Schroeder, Melanie, Sánchez, Silvia Esteban, Alcántara, Felipe Rodríguez
• Format: Article
• Language: English
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral therapy; CD4 antigen; CD4 Lymphocyte Count; Comorbidity; Cross-Sectional Studies; Demographic variables; Disease transmission; Drug interaction; Drug interactions; Drug Resistance, Multiple, Viral; Female; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV resistance; Human immunodeficiency virus; Humans; Integrase; limited treatment options; Male; Middle Aged; Multidrug resistance; multidrug‐resistant HIV; Nucleoside analogs; Nucleosides; Patients; Prevalence; Protease inhibitors; Proteinase inhibitors; Regression analysis; Retrospective Studies; RNA-directed DNA polymerase; salvage antiretroviral therapy; Spain - epidemiology; Viral Load
• ISSN: 1464-2662; 1468-1293; 1468-1293
• DOI: 10.1111/hiv.13650

Objectives Our aim was to determine the prevalence and characteristics of people with HIV on antiretroviral therapy (ART) with multidrug resistance (MDR; confirmed resistance to three or more [or resistance to two or more plus contraindication to one or more] core ART classes) and limited treatment options (LTOs) in Spain. Methods This was an observational, retrospective, multicentre, cross‐sectional chart review study undertaken in five reference Spanish centres. Participants were people with HIV on ART with MDR and LTOs (detectable viral load [HIV‐RNA >200 copies/mL], treatment‐limiting drug–drug interaction [DDI], or intolerance precluding the use of one or more ART classes). Prevalence, demographic/clinical characteristics, and treatment options were assessed. Logistic regression analyses were used to identify MDR‐associated variables. Results Of 14 955 screened people with HIV, 69 (0.46%) presented with MDR and 23 (0.15%) had LTOs. The population analysed was 73.9% male with a median age of 54.0 years; the median time since HIV diagnosis was 26.5 years, and median CD4+ cell count was 511.0 cells/μL. The only factor significantly associated with MDR (univariate analysis) was CD4+ cell count. Injection drug use was the most common transmission route. Comorbidities (mainly endocrine and cardiovascular disorders; 34.8% affecting HIV management) and concomitant treatments were frequent. No recent opportunistic infections were reported. Patients had been exposed to the following ART: nucleoside analogue reverse transcriptase inhibitors (100%), protease inhibitors (95.6%), non‐nucleoside analogue reverse transcriptase inhibitors (87.0%), and integrase strand transfer inhibitors (82.6%). The available fully active drugs were dolutegravir (39.1%), bictegravir (30.4%), and raltegravir (21.7%). Conclusions The prevalence of people with HIV with MDR and LTOs in Spain is very low, with approximately half of those studied not exhibiting virological suppression. Low CD4+ cell counts were associated with MDR. These findings may help address the impact and treatment needs of these patients and prevent clinical progression and transmission of MDR HIV.