Pretreatment HIV drug Resistance and Treatment Failure in Non-Italian HIV-1-Infected Patients Enrolled in ARCA

Abstract

Background An increase in pretreatment drug resistance (PDR) to first-line antiretroviral therapy (ART) in low-income countries has been recently described. Herein we analyse the prevalence of PDR and risk of virological failure (VF) over time among migrants to Italy enrolled in ARCA. Methods HIV-1 sequences from ART-naive patients of non-Italian nationality were retrieved from ARCA database from 1998 to 2017. PDR was defined by at least one mutation from the reference 2009 WHO surveillance list. Results Protease/reverse transcriptase sequences from 1,155 patients, mainly migrants from sub-Saharan Africa (SSA; 42%), followed by Latin America (LA; 25%) and Western countries (WE; 21%), were included. PDR was detected in 8.6% of sequences (13.1% versus 5.8% for B and non-B strains, respectively; P<0.001), 2.1% of patients carried a PDR for protease inhibitors (PIs; 2.1% versus 2.3%; P=0.893), 3.9% for nucleoside/ nucleotide reverse transcriptase inhibitors (NRTIs; 6.8% versus 2.1%; P<0.001) and 4.3% for non-nucleoside/ nucleotide reverse transcriptase inhibitors (NNRTIs; 6.3% versus 3.1%; P=0.013). Overall, prevalence of PDR over the years remained stable, while it decreased for PIs in LA (P=0.021) and for NRTIs (P=0.020) among migrants from WE. Having more than one class of PDR (P=0.015 versus absence of PDR), higher viral load at diagnosis (P=0.008) and being migrants from SSA (P=0.001 versus WE) were predictive of VF, while a recent calendar year of diagnosis (P<0.001) was protective for VF. Conclusions PDR appeared to be stable over the years in migrants to Italy enrolled in ARCA; however, it still remains an important cause of VF together with viral load at diagnosis.

Evaluation of HIV Transmission Clusters among Natives and Foreigners Living in Italy

“…This TDR prevalence is slightly higher than in other studies [ 7 , 39 , 46 , 48 ] because in the analysis, we considered the E138A mutation, associated with resistance to etravirine and rilpivirine [ 49 , 50 , 51 , 52 ]. In fact, by removing this mutation, the overall prevalence of TDR in our study population was found to be 9.8%, similar to that already reported in literature [ 7 , 10 , 42 , 46 , 48 , 53 ], remaining mainly attributed to NNRTI resistance (4.8%). As E138A is a polymorphic mutation that ranges in prevalence from about 1% to 5% depending on subtype [ 54 ], its high prevalence in our population might not necessarily be related to TDR.…”

HIV virological non-suppression and its associated factors in children on antiretroviral therapy at a major treatment centre in Southern Ghana: a cross-sectional study

“…Rountine VL monitoring is also important for early detection of treatment failure due to pre-treatment drug resistance (PDR), which is known to compromise the efficacy of ART at an individual and population level [ 33 ]. Bavara et al using a large database created for surveillance of HIV-1 drug resistance in Italy confirmed that having more than one PDR is an important predictor of virological failure [ 33 ]. This phenomenon is on the increase and has also been reported in sub-Saharan Africa [ 34 , 35 ] Latin America [ 36 ] and Asia [ 37 ].…”

Prevalence and factors associated with adverse drug events among patients on dolutegravir-based regimen at the Immune Suppression Syndrome Clinic of Mbarara Regional Referral Hospital, Uganda: a mixed design study

“…Progress towards achieving the 95-95-95 target has been made however, a rise in pretreatment drug resistance to first-line ART and adverse drug events (ADEs) among others pose a serious threat to strides made in low income countries such as Uganda hence need for more potent ART with higher genetic barrier to drug resistance, better safety and toxicity profile [ 4 , 5 ].…”