Abstract

Transmission of HIV drug resistance in Europe

A.M. Wensing¹, J. Vercauteren², D.A. Vijver¹, J. Albert³, G. Poggensee⁴, J.-C. Schmit⁵, D. Struck⁵, A.M. Vandamme², B. Åsjö⁶, C. Balotta⁷, R. Camacho⁸, S. Coughlan⁹, Z. Grossman¹⁰, A. Horban¹¹, C. Kücherer¹², C. Nielsen¹³, D. Paraskevis¹⁴, E. Puchhammer-Stöckl¹⁵, C. Riva⁷, L. Ruiz¹⁶, M. Salminen¹⁷, R. Schuurman¹, A. Sonnerborg¹⁸, M. Stanojevic¹⁹, C.A. Boucher¹, on behalf of the SPREAD-programme

¹University Medical Center Utrecht, Eijkman Winkler Center, Dept of Virology, Utrecht, Netherlands, ²Katholieke Universiteit Leuven, Rega Institute, Leuven, Belgium, ³Swedish Institute for Infectious Disease Control, Dept of Clinical Virology, Solna, Sweden, ⁴Robert Koch Institute, Dept. of Infectious Disease Epidemiology, Berlin, Germany, ⁵Centre Hospitalier de Luxembourg, Retrovirology Laboratory, Luxembourg, Luxembourg, ⁶University of Bergen, Center for Research in Virology, Oslo, Norway, ⁷University of Milan, Institute of Infectious and Tropical Diseases, Milan, Italy, ⁸Hospital Egas Moniz, Virology Laboratory, Lisbon, Portugal, ⁹University College Dublin, National Virus Reference Laboratory, Dublin, Ireland, ¹⁰Sheba Medical Center, National HIV Reference Laboratory, Tel-Hashomer, Israel, ¹¹Hospital for Infectious Diseases, AIDS Diagnosis and Therapy Center, Warsaw, Poland, ¹²Robert Koch Institute, Dept. of Virology, Berlin, Germany, ¹³Statens Serum Institute, Retrovirus Laboratory, Copenhagen, Denmark, ¹⁴Athens University Medical School, National Retrovirus Reference Center, Athens, Greece, ¹⁵University of Vienna, Institute of Virology, Vienna, Austria, ¹⁶IRSICAIXA Foundation, Retrovirology Laboratory, Badalona, Spain, ¹⁷National Publich Health Institute, HIV laboratory and Dept of infectious disease epidemiology, Helsinki, Finland, ¹⁸Karolinska University Hospital, Division of Infectious Diseases Department of Medicine, Stockholm, Sweden, ¹⁹University of Belgrade School of Medicine, Ministery of Health, Institute of Microbiology and Immunology, Belgrade, Serbia and Montenegro

Background: In Europe an official European Commission supported programme monitors prospectively the prevalence of baseline HIV drug resistance and the risk factors involved in the spread of resistant HIV in 17 countries. Funding European Comission (QLK2-CT-2001-01344).

Methods: & Population characteristics: Newly diagnosed individuals were recruited prospectively and clinical, demographic and behavioral data were collected. In 2002/2003 a total of 1083 newly diagnosed individuals were included, source of infection was: homo/bisexual (44%), heterosexual contact (42%) or iv-drug use (9%). 34% were from outside Western-Europe. 74% were asymptomatic (CDC class A). 22% had laboratory evidence of recent seroconversion (<1 year). Over 13 subtypes/CRFs were identified, predominantly B 66%, A 9%, C 9%, G 4% and CRF02_AG 4%.

Results: 9.1% (96/1050, CI95% 7.5 – 11.1%) of individuals harbored viruses with drug resistance mutations (IAS-list). Prevalence was higher in seroconverters than in patients with undefined duration of infection (10.6% vs 8.7, OR =1.2 (0.7-2.2;p=0.37). The prevalence of NRTI mutations was 5.4%, 1 out of 3 strains harbored more than one NRTI mutation. Most frequently observed were (n): 215Y/F/revertants (37), 41L (13), 219E/Q (10). The prevalence of PI mutations was 3.0%, most frequent observed were: 46I/L (15 ), 90M (13), 82I/F/T/S (8), The frequency of NNRTI mutations was 2.6%, mostly 103N(11) and 108I(8). Less than 1% was infected with a dual class resistant strain. Using an extensive list of risk factors no significant correlations were observed, except for individuals infected in a high prevalence country or infected with a non-B subtype virus, who had a significant lower risk of being infected with a strain harboring drug resistance mutations (5.2% vs 10.0, OR=0.49 (0.24-0.99;p=0.046)) and (6.3 vs 10.4, OR= 0.57 (0.35-0.95;p=0.03)).

Conclusions: The SPREAD-programme provides the first representative data on transmission of HIV drug-resistance across Europe. The prevalence of 9% baseline resistance in prospectively identified newly diagnosed patients warrants continuous surveillance.

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