Emmi Andersson1,2, Agnes Nordquist3, Joakim Esbjörnsson4,5, Leo Flamholc6, Magnus Gisslén7, Bo Hejdeman8, Gaetano Marrone9, Hans Norrgren10, Veronica Svedhem9,11, Suzanne Wendahl12, Jan Albert2,3, Anders Sönnerborg1,2,9,11. 1. Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institutet. 2. Department of Clinical Microbiology, Karolinska University Hospital. 3. Department of Microbiology, Tumor and Cell Biology, Karolinska Institutet, Stockholm, Sweden. 4. Nuffield Department of Medicine, University of Oxford, Oxford, UK. 5. Department of Laboratory Medicine, Lund University, Lund. 6. Department of Infectious Diseases, Skane University Hospital, Malmö. 7. Department of Infectious Diseases, Institute of Biomedicine, Sahlgrenska Academy, University of Gothenburg. 8. Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset. 9. Department of Infectious Diseases, Karolinska University Hospital, Stockholm. 10. Department of Clinical Sciences Lund, Lund University, Lund. 11. Unit of Infectious Diseases, Department of Medicine Huddinge, Karolinska Institutet, Stockholm. 12. Department of Infectious diseases, Sunderby Hospital, Luleå, Sweden.
Abstract
OBJECTIVE: To study the trends of transmitted drug resistance (TDR) in HIV-1 patients newly diagnosed in Sweden, 2010-2016. DESIGN: Register-based study including all antiretroviral therapy-naive patients ≥18 years diagnosed with HIV-1 in Sweden 2010-2016. METHODS: Patient data and viral pol sequences were extracted from the national InfCareHIV database. TDR was defined as the presence of surveillance drug resistance mutations (SDRMs). A CD4 T-cell decline trajectory model estimated time of infection. Phylogenetic inference was used for cluster analysis. Chi-square tests and logistic regressions were used to investigate relations between TDR, epidemiological and viral factors. RESULTS: One thousand, seven hundred and thirteen pol sequences were analyzed, corresponding to 71% of patients with a new HIV-1 diagnosis (heterosexuals: 53%; MSM: 34%). The overall prevalence of TDR was 7.1% (95% CI 5.8-8.3%). Nonnucleoside reverse transcriptase inhibitor (NNRTI) TDR increased significantly from 1.5% in 2010 to 6.2% in 2016, and was associated to infection and/or origin in sub-Saharan Africa (SSA). An MSM transmission cluster dating back to the 1990s with the M41L SDRM was identified. Twenty-five (1.5%) patients exhibited TDR to tenofovir (TDF; n = 8), emtricitabine/lamivudine (n = 9) or both (n = 8). CONCLUSION: NNRTI TDR has increased from 2010 to 2016 in HIV-1-infected migrants from SSA diagnosed in Sweden, mirroring the situation in SSA. TDR to tenofovir/emtricitabine, used in preexposure prophylaxis, confirms the clinical and epidemiological need for resistance testing in newly diagnosed patients.
OBJECTIVE: To study the trends of transmitted drug resistance (TDR) in HIV-1patients newly diagnosed in Sweden, 2010-2016. DESIGN: Register-based study including all antiretroviral therapy-naive patients ≥18 years diagnosed with HIV-1 in Sweden 2010-2016. METHODS:Patient data and viral pol sequences were extracted from the national InfCareHIV database. TDR was defined as the presence of surveillance drug resistance mutations (SDRMs). A CD4 T-cell decline trajectory model estimated time of infection. Phylogenetic inference was used for cluster analysis. Chi-square tests and logistic regressions were used to investigate relations between TDR, epidemiological and viral factors. RESULTS: One thousand, seven hundred and thirteen pol sequences were analyzed, corresponding to 71% of patients with a new HIV-1 diagnosis (heterosexuals: 53%; MSM: 34%). The overall prevalence of TDR was 7.1% (95% CI 5.8-8.3%). Nonnucleoside reverse transcriptase inhibitor (NNRTI) TDR increased significantly from 1.5% in 2010 to 6.2% in 2016, and was associated to infection and/or origin in sub-Saharan Africa (SSA). An MSM transmission cluster dating back to the 1990s with the M41L SDRM was identified. Twenty-five (1.5%) patients exhibited TDR to tenofovir (TDF; n = 8), emtricitabine/lamivudine (n = 9) or both (n = 8). CONCLUSION: NNRTI TDR has increased from 2010 to 2016 in HIV-1-infected migrants from SSA diagnosed in Sweden, mirroring the situation in SSA. TDR to tenofovir/emtricitabine, used in preexposure prophylaxis, confirms the clinical and epidemiological need for resistance testing in newly diagnosed patients.
Authors: Marita Jw van de Laar; Arnold Bosman; Anastasia Pharris; Emmi Andersson; Lambert Assoumou; Eva Ay; Norbert Bannert; Barbara Bartmeyer; Melissa Brady; Marie-Laure Chaix; Diane Descamps; Kenny Dauwe; Jannik Fonager; Andrea Hauser; Maja Lunar; Maria Mezei; Martha Neary; Mario Poljak; Ard van Sighem; Chris Verhofstede; Andrew J Amato-Gauci; Eeva K Broberg Journal: Euro Surveill Date: 2019-05