Analysis of transmitted drug resistance in Spain in the years 2007–2010 documents a decline in mutations to the non-nucleoside drug class

Monge, Susana; Guillot, Vicente; Álvarez, Marta; Peña, Alejandro; Viciana, Pompeyo; García, Felipe; Elías, Maria Jesús Pérez; Iribarren, José Antonio; Gutiérrez, Félix; Casado, Itziar; García, Féderico; CoRIS,

doi:10.1111/1469-0691.12011

Cited by 26 publications

(23 citation statements)

References 20 publications

(19 reference statements)

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“…However, characteristics of the weighted sample were fairly similar to SINIVIH, with only an infra-representation of foreigners persisting. It is unclear how this limitation may have influenced our results, although in our previous reports [6] we found no association of region of origin with TDR. It was not possible to investigate weighted temporal trends because of the limited sample size.…”

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confidence: 57%

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Use of cohort data to estimate national prevalence of transmitted drug resistance to antiretroviral drugs in Spain (2007–2012)

Monge

Díez

Álvarez

et al. 2015

Clinical Microbiology and Infection

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Prevalence of transmitted drug resistance (pTDR) to antiretroviral drugs in Spain (2007-2012) was estimated using the CoRIS cohort, adjusting its territorial distribution and transmission route to the reference population from the Spanish Information System on New human immunodeficiency virus diagnoses. A total of 2702 patients from ten autonomous communities and with naive FASTA sequence within 6 months of human immunodeficiency virus diagnosis were selected. Weighted pTDR, estimated using the inverse probability of selection in the sample by autonomous communities and transmission group, was 8.12% (95% CI 6.44-9.80), not significantly different from unweighted pTDR. We illustrate how proportional weighting can maximize representativeness of cohort-based data, and its value to monitor pTDR at country level.

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confidence: 57%

“…CoRIS collects FASTA sequences encoding the HIV reverse transcriptase and protease, if available, from routine resistance testing. Previous studies on TDR have been published for data between 2004 and 2011 [5][6][7]. As of December 2012, 29 sites from ten autonomous communities were contributing FASTA sequences.…”

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confidence: 99%

Use of cohort data to estimate national prevalence of transmitted drug resistance to antiretroviral drugs in Spain (2007–2012)

Monge

Díez

Álvarez

et al. 2015

Clinical Microbiology and Infection

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“…Many studies have evaluated trends in TDR transmission across Europe and the US [10], [11], [13]–[16], [18]–[21]. The use of the 2009 update of the WHO surveillance recommendations for the estimation of TDR has brought uniformity to all TDR surveys, and has had the great benefit of making all these studies comparable.…”

Section: Discussionmentioning

confidence: 99%

“…Two previous analyses of viral sequences in CoRIS were carried out for the periods 2004–2008 and 2007–2010, and have been published elsewhere [10], [11]. For these two previous studies, we used the 2009 update World Health Organization (WHO) comprehensive list of mutations [12], which has been also widely used for TDR evaluation [13]–[16] …”

Section: Introductionmentioning

confidence: 99%

Clinically Relevant Transmitted Drug Resistance to First Line Antiretroviral Drugs and Implications for Recommendations

et al. 2014

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BackgroundThe aim was to analyse trends in clinically relevant resistance to first-line antiretroviral drugs in Spain, applying the Stanford algorithm, and to compare these results with reported Transmitted Drug Resistance (TDR) defined by the 2009 update of the WHO SDRM list.MethodsWe analysed 2781 sequences from ARV naive patients of the CoRIS cohort (Spain) between 2007–2011. Using the Stanford algorithm “Low-level resistance”, “Intermediate resistance” and “High-level resistance” categories were considered as “Resistant”.Results70% of the TDR found using the WHO list were relevant for first-line treatment according to the Stanford algorithm. A total of 188 patients showed clinically relevant resistance to first-line ARVs [6.8% (95%Confidence Interval: 5.8–7.7)], and 221 harbored TDR using the WHO list [7.9% (6.9–9.0)]. Differences were due to a lower prevalence in clinically relevant resistance for NRTIs [2.3% (1.8–2.9) vs. 3.6% (2.9–4.3) by the WHO list] and PIs [0.8% (0.4–1.1) vs. 1.7% (1.2–2.2)], while it was higher for NNRTIs [4.6% (3.8–5.3) vs. 3.7% (3.0–4.7)]. While TDR remained stable throughout the study period, clinically relevant resistance to first line drugs showed a significant trend to a decline (p = 0.02).ConclusionsPrevalence of clinically relevant resistance to first line ARVs in Spain is decreasing, and lower than the one expected looking at TDR using the WHO list. Resistance to first-line PIs falls below 1%, so the recommendation of screening for TDR in the protease gene should be questioned in our setting. Cost-effectiveness studies need to be carried out to inform evidence-based recommendations.

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“…mutations at codons 138, 221 and 227) [2][3][4][5], little information on the prevalence of transmitted rilpivirine RAMs is available [6][7][8]. We have previously reported transmitted drug resistance over different periods in Spain [9][10][11], but none of these reports evaluated rilpivirine transmitted drug resistance. In addition to transmitted drug resistance, we have also characterized clinically relevant transmitted drug resistance.…”

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Transmitted drug resistance to rilpivirine in newly diagnosed antiretroviral naive adults

Álvarez

Monge

Chueca

et al. 2015

Clinical Microbiology and Infection

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We characterized transmitted drug resistance to rilpivirine and the predicted efficacy of first-line rilpivirine-containing regimens in antiretroviral-naive Spanish patients. International Antiviral Society-USA mutations were detected in 138 of 2781 patients (4.9%), E138A (3.4%) being the most prevalent. Using the Stanford Algorithm, 121 patients (4.4%) showed low-level or intermediate resistance. No differences in the predicted efficacy of first-line non-nucleoside reverse transcriptase inhibitor-based regimens were observed. As rilpivirine becomes more widely used in clinical practice, the evolution of its transmitted drug resistance will need to be monitored. In addition, the exact role of E138A singletons on rilpivirine activity as part of first-line regimens merits further evaluation.

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Analysis of transmitted drug resistance in Spain in the years 2007–2010 documents a decline in mutations to the non-nucleoside drug class

Cited by 26 publications

References 20 publications

Use of cohort data to estimate national prevalence of transmitted drug resistance to antiretroviral drugs in Spain (2007–2012)

Use of cohort data to estimate national prevalence of transmitted drug resistance to antiretroviral drugs in Spain (2007–2012)

Clinically Relevant Transmitted Drug Resistance to First Line Antiretroviral Drugs and Implications for Recommendations

Transmitted drug resistance to rilpivirine in newly diagnosed antiretroviral naive adults

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