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Increase in transmitted drug resistance in migrants from sub-Saharan Africa diagnosed with HIV-1 in Sweden

Andersson, Emmi; Nordquist, Agnes; Esbjörnsson, Joakim LU ; Flamholc, Leo LU ; Gisslén, Magnus; Hejdeman, Bo; Marrone, Gaetano; Norrgren, Hans LU ; Svedhem, Veronica and Wendahl, Suzanne, et al. (2018) In AIDS 32(7). p.877-884
Abstract

Objective: To study the trends of transmitted drug resistance (TDR) in HIV-1 patients newly diagnosed in Sweden, 2010-2016. Design: Register-based study including all antiretroviral therapy-naive patients ≥18 years diagnosed with HIV-1 in Sweden 2010-2016. Methods: Patient data and viral pol sequences were extracted from the national InfCareHIV database. TDR was defined as the presence of surveillance drug resistance mutations (SDRMs). A CD4+ T-cell decline trajectory model estimated time of infection. Phylogenetic inference was used for cluster analysis. Chi-square tests and logistic regressions were used to investigate relations between TDR, epidemiological and viral factors. Results: One thousand, seven hundred and... (More)

Objective: To study the trends of transmitted drug resistance (TDR) in HIV-1 patients newly diagnosed in Sweden, 2010-2016. Design: Register-based study including all antiretroviral therapy-naive patients ≥18 years diagnosed with HIV-1 in Sweden 2010-2016. Methods: Patient data and viral pol sequences were extracted from the national InfCareHIV database. TDR was defined as the presence of surveillance drug resistance mutations (SDRMs). A CD4+ T-cell decline trajectory model estimated time of infection. Phylogenetic inference was used for cluster analysis. Chi-square tests and logistic regressions were used to investigate relations between TDR, epidemiological and viral factors. Results: One thousand, seven hundred and thirteen pol sequences were analyzed, corresponding to 71% of patients with a new HIV-1 diagnosis (heterosexuals: 53%; MSM: 34%). The overall prevalence of TDR was 7.1% (95% CI 5.8-8.3%). Nonnucleoside reverse transcriptase inhibitor (NNRTI) TDR increased significantly from 1.5% in 2010 to 6.2% in 2016, and was associated to infection and/or origin in sub-Saharan Africa (SSA). An MSM transmission cluster dating back to the 1990s with the M41L SDRM was identified. Twenty-five (1.5%) patients exhibited TDR to tenofovir (TDF; n = 8), emtricitabine/lamivudine (n = 9) or both (n = 8). Conclusion: NNRTI TDR has increased from 2010 to 2016 in HIV-1-infected migrants from SSA diagnosed in Sweden, mirroring the situation in SSA. TDR to tenofovir/emtricitabine, used in preexposure prophylaxis, confirms the clinical and epidemiological need for resistance testing in newly diagnosed patients.

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Contribution to journal
publication status
published
subject
keywords
antiretroviral drugs, drug resistance, HIV, sub-Saharan Africa, Sweden, transients and migrants, transmission
in
AIDS
volume
32
issue
7
pages
8 pages
publisher
Lippincott Williams & Wilkins
external identifiers
  • scopus:85045219502
ISSN
0269-9370
DOI
10.1097/QAD.0000000000001763
language
English
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yes
id
48e08501-dca3-4f9b-ab57-0562d35059f2
date added to LUP
2018-04-18 07:42:20
date last changed
2019-01-06 13:51:38
@article{48e08501-dca3-4f9b-ab57-0562d35059f2,
  abstract     = {<p>Objective: To study the trends of transmitted drug resistance (TDR) in HIV-1 patients newly diagnosed in Sweden, 2010-2016. Design: Register-based study including all antiretroviral therapy-naive patients ≥18 years diagnosed with HIV-1 in Sweden 2010-2016. Methods: Patient data and viral pol sequences were extracted from the national InfCareHIV database. TDR was defined as the presence of surveillance drug resistance mutations (SDRMs). A CD4<sup>+</sup> T-cell decline trajectory model estimated time of infection. Phylogenetic inference was used for cluster analysis. Chi-square tests and logistic regressions were used to investigate relations between TDR, epidemiological and viral factors. Results: One thousand, seven hundred and thirteen pol sequences were analyzed, corresponding to 71% of patients with a new HIV-1 diagnosis (heterosexuals: 53%; MSM: 34%). The overall prevalence of TDR was 7.1% (95% CI 5.8-8.3%). Nonnucleoside reverse transcriptase inhibitor (NNRTI) TDR increased significantly from 1.5% in 2010 to 6.2% in 2016, and was associated to infection and/or origin in sub-Saharan Africa (SSA). An MSM transmission cluster dating back to the 1990s with the M41L SDRM was identified. Twenty-five (1.5%) patients exhibited TDR to tenofovir (TDF; n = 8), emtricitabine/lamivudine (n = 9) or both (n = 8). Conclusion: NNRTI TDR has increased from 2010 to 2016 in HIV-1-infected migrants from SSA diagnosed in Sweden, mirroring the situation in SSA. TDR to tenofovir/emtricitabine, used in preexposure prophylaxis, confirms the clinical and epidemiological need for resistance testing in newly diagnosed patients.</p>},
  author       = {Andersson, Emmi and Nordquist, Agnes and Esbjörnsson, Joakim and Flamholc, Leo and Gisslén, Magnus and Hejdeman, Bo and Marrone, Gaetano and Norrgren, Hans and Svedhem, Veronica and Wendahl, Suzanne and Albert, Jan and Sönnerborg, Anders},
  issn         = {0269-9370},
  keyword      = {antiretroviral drugs,drug resistance,HIV,sub-Saharan Africa,Sweden,transients and migrants,transmission},
  language     = {eng},
  month        = {04},
  number       = {7},
  pages        = {877--884},
  publisher    = {Lippincott Williams & Wilkins},
  series       = {AIDS},
  title        = {Increase in transmitted drug resistance in migrants from sub-Saharan Africa diagnosed with HIV-1 in Sweden},
  url          = {http://dx.doi.org/10.1097/QAD.0000000000001763},
  volume       = {32},
  year         = {2018},
}