Trends in antiretroviral therapy and prevalence of HIV drug resistance mutations in Sweden 1997-2011

• Published in: PloS one Vol. 8; no. 3; p. e59337
• Main Authors: Bontell, Irene, Häggblom, Amanda, Bratt, Göran, Albert, Jan, Sönnerborg, Anders
• Format: Journal Article
• Language: English
• Published: United States Public Library of Science 22.03.2013; Public Library of Science (PLoS)
• Subjects: Adult; Anti-HIV Agents - therapeutic use; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Antiviral agents; Biology; Data bases; Demographics; Drug resistance; Drug Resistance, Viral - genetics; Drug therapy; Epidemics; Female; Folkhälsovetenskap, global hälsa, socialmedicin och epidemiologi; Highly active antiretroviral therapy; HIV; HIV (Viruses); HIV Infections - drug therapy; HIV Infections - epidemiology; Human immunodeficiency virus; Humans; Hälsovetenskap; Immunologi inom det medicinska området; Infektionsmedicin; Klinisk medicin; Male; Medicin och hälsovetenskap; Medicine; Medicinska och farmaceutiska grundvetenskaper; Middle Aged; Mutation; Patients; Protease inhibitors; Studies; Sweden - epidemiology; Trends; Viruses; Sweden; United States > US
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0059337

Describe trends in antiretroviral treatments and drug resistance mutations among Swedish HIV-patients over time 1997-2011. Treatment histories, viral sequences, and demographic and clinical data were retrieved from the national database InfCareHIV. All ART-experienced patients were included (N = 6537), while resistance tests were restricted to those obtained ≥90 days after ART start. This cohort is fully representative for Sweden since the database covers virtually all diagnosed HIV-patients since the start of the epidemic. Patients were grouped according to the year of first ART, and treatments and mutations were analyzed by calendar year. The prevalence of major drug resistance mutations decreased dramatically over time, most rapidly between 2003 and 2007. Since then there has been a continued slow decrease for NRTI- and PI-associated mutations with an overall prevalence among all ART-experienced patients at 1.1% (NRTI) and 0.3% (PI) in 2011. NNRTI resistance reached the lowest level in 2007-2009 (0.6%), but is now increasing (0.9% in 2011). Patients with first ART exposure before 2001 are still highly overrepresented among those with PI and, to a lesser extent, NRTI resistance. In contrast, almost half of the patients with NNRTI mutations in 2011 initiated their first ART after 2007. Tremendous improvements in ART options and knowledge have resulted in rapidly declining levels of resistance, and most of the current NRTI and PI mutations are found among patients with a history of suboptimal treatments. However, NNRTI resistance is increasing and is primarily found in patients infected in low- and middle-income countries who initiated ART in recent years. It is plausible that these patients were infected with resistant strains and it is therefore suggested that resource-rich countries like Sweden should test for resistance in minor quasispecies or use PI-based first-line regimens in patients who are at increased risk of carrying resistant virus.