Marta Alvarez1, Paz Casas1, Adolfo de Salazar1, Natalia Chueca1, Carlos Guerrero-Beltran1, Carmen Rodríguez2, Arkaitz Imaz3, Nuria Espinosa4, Silvia García-Bujalance5, María Jesús Pérez-Elías6, Mónica García-Alvarez7, Jose Antonio Iribarren8, Jesús Santos9, David Dalmau10, Antonio Aguilera11, David Vinuesa12, Félix Gutiérrez13, Beatriz Piérola14, José Miguel Molina15, Joaquim Peraire16, Irene Portilla17, Juan Luis Gómez-Sirvent18, Julián Olalla19, Carlos Galera20, José Ramón Blanco21, Melchor Riera22, Lucio García-Fraile23, Gemma Navarro24, Adrían Curran25, Eva Poveda26, Federico García1. 1. Unidad de Microbiología Clínica, Hospital Universitario San Cecilio, Granada, Instituto de Investigacion Ibs., Granada, Spain. 2. Clínica Sandoval, Madrid, Spain. 3. Unidad de VIH e ITS, Departamento de Enfermedades Infecciosas, Hospital Universitari de Bellvitge-IDIBELL, L'Hospitalet de Llobregat, Barcelona, Spain. 4. Unidad de Enfermedades Infecciosas, Hospital Virgen del Rocio, Sevilla, Spain. 5. Unidad de Enfermedades Infecciosas, Hospital Universitario La Paz, Madrid, Spain. 6. Unidad de Enfermedades Infecciosas, Hospital Universitario Ramón y Cajal, Madrid, Spain. 7. Unidad de Microbiología Clínica, Hospital Universitario Doce de Octubre, Madrid, Spain. 8. Unidad de Enfermedades Infecciosas, Hospital Universitario Donostia, Instituto BioDonostia, Donostia, Spain. 9. Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Victoria, Málaga, Spain. 10. Unidad de Enfermedades Infecciosas, Hospital Universitario Mutua Terrasa, Terrasa, Spain. 11. Servicio y Departamento de Microbiología, Complejo Hospitalario Universitario de Santiago y Universidad de Santiago de Compostela, Santiago de Compostela, Spain. 12. Unidad de Enfermedades Infecciosas, Hospital Universitario, Universitario San Cecilio, Granada, Spain. 13. Unidad de Enfermedades Infecciosas, Hospital Universitario de Elche & Universidad Miguel Hernández, Alicante, Spain. 14. Unidad de Enfermedades Infecciosas, Complejo Hospitalario de Navarra, Pamplona, Spain. 15. Unidad de Microbiología Clínica, Hospital Universitario La Fe, Valencia, Spain. 16. Unidad de Enfermedades Infecciosas, Hospital Universitari de Tarragona Joan XXIII, IISPV, Universitat Rovira i Virgili, Tarragona, Spain. 17. Unidad de Enfermedades Infecciosas, Hospital Universitario Alicante, Alicante, Spain. 18. Unidad de Enfermedades Infecciosas, Hospital Universitario de Canarias, Santa Cruz de Tenerife, Spain. 19. Unidad de Enfermedades Infecciosas, Hospital Costa del Sol, Marbella, Spain. 20. Unidad de Enfermedades Infecciosas, Hospital Universitario Virgen de la Arrixaca, Murcia, Spain. 21. Unidad de Enfermedades Infecciosas, Hospital Universitario San Pedro, Logroño, Spain. 22. Unidad de Enfermedades Infecciosas, Hospital Universitario Son Espases, Palma de Mallorca, Spain. 23. Unidad de Enfermedades Infecciosas, Hospital Universitario La Princesa, Madrid, Spain. 24. Unidad de Enfermedades Infecciosas, Hospital Universitario Parc Taulí, Sabadell, Spain. 25. Servicio de Enfermedades Infecciosas, Hospital Universitario Vall d´Hebron, Barcelona, Spain. 26. Group of Virology and Pathogenesis, Galicia Sur Health Research Institute (IIS Galicia Sur)-Complexo Hospitalario Universitario de Vigo, SERGAS-UVigo, Spain.
Abstract
BACKGROUND: Integrase strand-transfer inhibitors (INSTIs) constitute at present one of the pillars of first-line ART. OBJECTIVES: To study the prevalence of and the trend in transmitted drug resistance (TDR) to INSTIs in ART-naive patients in Spain. METHODS: During the period 2012-17, 1109 patients from CoRIS were analysed. The Stanford algorithm v8.7 was used to evaluate TDR and transmission of clinically relevant resistance. To describe individual mutations/polymorphisms, the most recent IAS list (for INSTIs) and the 2009 WHO list update (for the backbone NRTIs used in combination with INSTIs in first-line treatment) were used. RESULTS: Clinically relevant resistance to the INSTI class was 0.2%: T66I, 0.1%, resistance to elvitegravir and intermediate resistance to raltegravir; and G163K, 0.1%, intermediate resistance to raltegravir and elvitegravir. No clinical resistance to dolutegravir or bictegravir was observed. The prevalence of INSTI TDR following the IAS-USA INSTI mutation list was 2.6%, with no trend towards changes in the prevalence throughout the study period. The overall prevalence of NRTI WHO mutations was 4.3%, whereas clinically relevant resistance to tenofovir, abacavir and emtricitabine/lamivudine was 1.7%, 1.9% and 0.7%, respectively. CONCLUSIONS: Given the low prevalence of clinically relevant resistance to INSTIs and first-line NRTIs in Spain, it is very unlikely that a newly diagnosed patient will present with clinical resistance to a first-line INSTI-based regimen. These patients may not benefit from INSTI and NRTI baseline resistance testing.
BACKGROUND: Integrase strand-transfer inhibitors (INSTIs) constitute at present one of the pillars of first-line ART. OBJECTIVES: To study the prevalence of and the trend in transmitted drug resistance (TDR) to INSTIs in ART-naive patients in Spain. METHODS: During the period 2012-17, 1109 patients from CoRIS were analysed. The Stanford algorithm v8.7 was used to evaluate TDR and transmission of clinically relevant resistance. To describe individual mutations/polymorphisms, the most recent IAS list (for INSTIs) and the 2009 WHO list update (for the backbone NRTIs used in combination with INSTIs in first-line treatment) were used. RESULTS: Clinically relevant resistance to the INSTI class was 0.2%: T66I, 0.1%, resistance to elvitegravir and intermediate resistance to raltegravir; and G163K, 0.1%, intermediate resistance to raltegravir and elvitegravir. No clinical resistance to dolutegravir or bictegravir was observed. The prevalence of INSTI TDR following the IAS-USA INSTI mutation list was 2.6%, with no trend towards changes in the prevalence throughout the study period. The overall prevalence of NRTI WHO mutations was 4.3%, whereas clinically relevant resistance to tenofovir, abacavir and emtricitabine/lamivudine was 1.7%, 1.9% and 0.7%, respectively. CONCLUSIONS: Given the low prevalence of clinically relevant resistance to INSTIs and first-line NRTIs in Spain, it is very unlikely that a newly diagnosed patient will present with clinical resistance to a first-line INSTI-based regimen. These patients may not benefit from INSTI and NRTI baseline resistance testing.
Authors: Jean L Mbisa; Juan Ledesma; Peter Kirwan; David F Bibby; Carmen Manso; Andrew Skingsley; Gary Murphy; Alison Brown; David T Dunn; Valerie Delpech; Anna Maria Geretti Journal: J Antimicrob Chemother Date: 2020-11-01 Impact factor: 5.790
Authors: Michelle L D'Antoni; Kristen Andreatta; Rima Acosta; Hal Martin; Silvia Chang; Ross Martin; Kirsten L White Journal: J Acquir Immune Defic Syndr Date: 2022-04-01 Impact factor: 3.771