High prevalence of HIV-1 transmitted drug resistance and factors associated with time to virological failure and viral suppression in Taiwan

Abstract

Background Integrase strand transfer inhibitor (InSTI)-based regimens have become the major first-line treatment for HIV-1-infected patients in Taiwan. Transmitted drug resistance (TDR) and several clinical characteristics are associated with time to virological failure or viral suppression; however, these have not been investigated in Taiwan. Objectives To determine the impact of several factors on treatment outcomes in HIV-1-infected patients in Taiwan. Methods The cohort included 164 HIV-1 treatment-naive patients in Taiwan from 2018 to 2020. Blood specimens were collected to determine the genotypic drug resistance using the Stanford University HIV drug resistance database. Cox proportional hazards models were used to identify factors associated with time to virological failure or viral suppression. Results The prevalence of TDR in Taiwan was 27.4% and an increasing trend was seen from 2018 to 2020. TDR mutations related to NNRTIs were the most prevalent (21%) while TDR to InSTIs remained at a relatively low level (1.3%). A baseline HIV-1 viral load of ≥100 000 copies/mL was associated with a shorter time to virological failure [multivariate hazard ratio (mHR) 7.84; P = 0.018] and longer time to viral suppression (mHR 0.46; P < 0.001). Time to viral suppression was shorter in patients receiving InSTI-based regimens (mHR 2.18; P = 0.006). Different InSTI-based regimens as initial treatment did not affect the treatment outcomes. Conclusions This study found an increasing trend of HIV-1 TDR prevalence from 2018 to 2020 in Taiwan. Baseline HIV-1 viral load and receiving InSTI-based regimens are important factors associated with time to virological failure or viral suppression.

Molecular transmission network of pretreatment drug resistance among human immunodeficiency virus-positive individuals and the impact of virological failure on those who received antiretroviral therapy in China

“…The E138G/K/A mutation (non-polymorphic) was not associated with susceptibility to resistance to any NNRTIs ( 27 ). The V179D mutation can cause drug resistance to several NNRTIs, and K103N (non-polymorphic) can induce resistance to NVP and EFV ( 28 , 29 ). M184V was one of the most frequently detected PDR mutations, consistent with studies in sub-Saharan Africa and Ethiopia ( 30 , 31 ).…”

“…Further studies on the factors influencing adherence to improve patient compliance are of national interest to the well-being of the health system ( 37 ). However, another survey found that the high prevalence of PDR was not associated with virological failure after ART, probably because patients were administered integrase strand transfer inhibitor (InSTI) regimens (one InSTI and two NRTIs) and had low levels of InSTI-related DRMs ( 29 ). We plan to conduct relevant studies on drug resistance of InSTI before ART in China in 2022.…”

Epidemiology of HIV drug resistance in low- and middle-income countries and WHO global strategy to monitor its emergence

“…Although the current WHO survey methodology is not designed to distinguish between PDR and TDR and incidence test are seldomly used in HIVDR prevalence studies or surveys, some studies reported an initial rise in TDR especially to NNRTI which declined possibly due to policy changes involving transition to well-tolerated and high genetic barrier drugs such as DTG-based ART [13][14][15][16][17][18]. On the other hand, the prevalence of TDR to INSTIs is still very low [18,19 & ,20-22].…”

“…). The proportion of countries meeting the target of having at least 5% of patients on secondline ART increased from 45% (13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) in 2017 to 56% (14 of 25) in 2020. Overall, most countries reported sub-optimal performance in preventing HIVDR, indicating the need to strengthen the quality and monitoring systems and implement sustainable solutions.…”

Trend of HIV Transmitted Drug Resistance After the Introduction of Single-Tablet Regimens in Southern Taiwan

“…Most previous studies of TDR in HIV-1-infected patients have been cross-sectional, spanned a short period of time, and used different drug resistance interpretational criteria. 14,15 No previous study has provided long-term observational resistance follow-up data or used the newest Stanford HIV Drug Resistance Database edition 9 to analyze the prevalence of resistance. Therefore, this study aimed to investigate the prevalence of TDR in HIV-infected patients newly diagnosed through the free national VCT program in southern Taiwan from 2013 to 2021, clarify the risk factors for drug resistance, and compare the trends of the prevalence of resistance before and after the introduction of STRs as the recommended regimen after June 2016.…”