HIV resistance testing and detected drug resistance in Europe

Anna Schultze, Andrew N Phillips, Roger Paredes, Manuel Battegay, Jürgen K Rockstroh, Ladislav Machala, Janez Tomazic, Pierre M Girard, Inga Januskevica, Kamilla Gronborg-Laut, Jens D Lundgren, Alessandro Cozzi-Lepri, EuroSIDA in EuroCoord, Court Pedersen

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

OBJECTIVES: To describe regional differences and trends in resistance testing among individuals experiencing virological failure and the prevalence of detected resistance among those individuals who had a genotypic resistance test done following virological failure.

DESIGN: Multinational cohort study.

METHODS: Individuals in EuroSIDA with virological failure (>1 RNA measurement >500 on ART after >6 months on ART) after 1997 were included. Adjusted odds ratios (aORs) for resistance testing following virological failure and aORs for the detection of resistance among those who had a test were calculated using logistic regression with generalized estimating equations.

RESULTS: Compared to 74.2% of ART-experienced individuals in 1997, only 5.1% showed evidence of virological failure in 2012. The odds of resistance testing declined after 2004 (global P < 0.001). Resistance was detected in 77.9% of the tests, NRTI resistance being most common (70.3%), followed by NNRTI (51.6%) and protease inhibitor (46.1%) resistance. The odds of detecting resistance were lower in tests done in 1997-1998, 1999-2000 and 2009-2010, compared to those carried out in 2003-2004 (global P < 0.001). Resistance testing was less common in Eastern Europe [aOR 0.72, 95% confidence interval (CI) 0.55-0.94] compared to Southern Europe, whereas the detection of resistance given that a test was done was less common in Northern (aOR 0.29, 95% CI 0.21-0.39) and Central Eastern (aOR 0.47, 95% CI 0.29-0.76) Europe, compared to Southern Europe.

CONCLUSIONS: Despite a concurrent decline in virological failure and testing, drug resistance was commonly detected. This suggests a selective approach to resistance testing. The regional differences identified indicate that policy aiming to minimize the emergence of resistance is of particular relevance in some European regions, notably in the countries in Eastern Europe.

Original languageEnglish
JournalAIDS
Volume29
Issue number11
Pages (from-to)1379-89
Number of pages11
ISSN0269-9370
DOIs
Publication statusPublished - 17. Jul 2015

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Drug Resistance
Eastern Europe
HIV
Confidence Intervals
Odds Ratio
Protease Inhibitors
Cohort Studies
Logistic Models
RNA

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Schultze, A., Phillips, A. N., Paredes, R., Battegay, M., Rockstroh, J. K., Machala, L., ... Pedersen, C. (2015). HIV resistance testing and detected drug resistance in Europe. AIDS, 29(11), 1379-89. https://doi.org/10.1097/QAD.0000000000000708
Schultze, Anna ; Phillips, Andrew N ; Paredes, Roger ; Battegay, Manuel ; Rockstroh, Jürgen K ; Machala, Ladislav ; Tomazic, Janez ; Girard, Pierre M ; Januskevica, Inga ; Gronborg-Laut, Kamilla ; Lundgren, Jens D ; Cozzi-Lepri, Alessandro ; EuroSIDA in EuroCoord ; Pedersen, Court. / HIV resistance testing and detected drug resistance in Europe. In: AIDS. 2015 ; Vol. 29, No. 11. pp. 1379-89.
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title = "HIV resistance testing and detected drug resistance in Europe",
abstract = "OBJECTIVES: To describe regional differences and trends in resistance testing among individuals experiencing virological failure and the prevalence of detected resistance among those individuals who had a genotypic resistance test done following virological failure.DESIGN: Multinational cohort study.METHODS: Individuals in EuroSIDA with virological failure (>1 RNA measurement >500 on ART after >6 months on ART) after 1997 were included. Adjusted odds ratios (aORs) for resistance testing following virological failure and aORs for the detection of resistance among those who had a test were calculated using logistic regression with generalized estimating equations.RESULTS: Compared to 74.2{\%} of ART-experienced individuals in 1997, only 5.1{\%} showed evidence of virological failure in 2012. The odds of resistance testing declined after 2004 (global P < 0.001). Resistance was detected in 77.9{\%} of the tests, NRTI resistance being most common (70.3{\%}), followed by NNRTI (51.6{\%}) and protease inhibitor (46.1{\%}) resistance. The odds of detecting resistance were lower in tests done in 1997-1998, 1999-2000 and 2009-2010, compared to those carried out in 2003-2004 (global P < 0.001). Resistance testing was less common in Eastern Europe [aOR 0.72, 95{\%} confidence interval (CI) 0.55-0.94] compared to Southern Europe, whereas the detection of resistance given that a test was done was less common in Northern (aOR 0.29, 95{\%} CI 0.21-0.39) and Central Eastern (aOR 0.47, 95{\%} CI 0.29-0.76) Europe, compared to Southern Europe.CONCLUSIONS: Despite a concurrent decline in virological failure and testing, drug resistance was commonly detected. This suggests a selective approach to resistance testing. The regional differences identified indicate that policy aiming to minimize the emergence of resistance is of particular relevance in some European regions, notably in the countries in Eastern Europe.",
author = "Anna Schultze and Phillips, {Andrew N} and Roger Paredes and Manuel Battegay and Rockstroh, {J{\"u}rgen K} and Ladislav Machala and Janez Tomazic and Girard, {Pierre M} and Inga Januskevica and Kamilla Gronborg-Laut and Lundgren, {Jens D} and Alessandro Cozzi-Lepri and {EuroSIDA in EuroCoord} and Court Pedersen",
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Schultze, A, Phillips, AN, Paredes, R, Battegay, M, Rockstroh, JK, Machala, L, Tomazic, J, Girard, PM, Januskevica, I, Gronborg-Laut, K, Lundgren, JD, Cozzi-Lepri, A, EuroSIDA in EuroCoord & Pedersen, C 2015, 'HIV resistance testing and detected drug resistance in Europe', AIDS, vol. 29, no. 11, pp. 1379-89. https://doi.org/10.1097/QAD.0000000000000708

HIV resistance testing and detected drug resistance in Europe. / Schultze, Anna; Phillips, Andrew N; Paredes, Roger; Battegay, Manuel; Rockstroh, Jürgen K; Machala, Ladislav; Tomazic, Janez; Girard, Pierre M; Januskevica, Inga; Gronborg-Laut, Kamilla; Lundgren, Jens D; Cozzi-Lepri, Alessandro; EuroSIDA in EuroCoord ; Pedersen, Court.

In: AIDS, Vol. 29, No. 11, 17.07.2015, p. 1379-89.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - HIV resistance testing and detected drug resistance in Europe

AU - Schultze, Anna

AU - Phillips, Andrew N

AU - Paredes, Roger

AU - Battegay, Manuel

AU - Rockstroh, Jürgen K

AU - Machala, Ladislav

AU - Tomazic, Janez

AU - Girard, Pierre M

AU - Januskevica, Inga

AU - Gronborg-Laut, Kamilla

AU - Lundgren, Jens D

AU - Cozzi-Lepri, Alessandro

AU - EuroSIDA in EuroCoord

AU - Pedersen, Court

PY - 2015/7/17

Y1 - 2015/7/17

N2 - OBJECTIVES: To describe regional differences and trends in resistance testing among individuals experiencing virological failure and the prevalence of detected resistance among those individuals who had a genotypic resistance test done following virological failure.DESIGN: Multinational cohort study.METHODS: Individuals in EuroSIDA with virological failure (>1 RNA measurement >500 on ART after >6 months on ART) after 1997 were included. Adjusted odds ratios (aORs) for resistance testing following virological failure and aORs for the detection of resistance among those who had a test were calculated using logistic regression with generalized estimating equations.RESULTS: Compared to 74.2% of ART-experienced individuals in 1997, only 5.1% showed evidence of virological failure in 2012. The odds of resistance testing declined after 2004 (global P < 0.001). Resistance was detected in 77.9% of the tests, NRTI resistance being most common (70.3%), followed by NNRTI (51.6%) and protease inhibitor (46.1%) resistance. The odds of detecting resistance were lower in tests done in 1997-1998, 1999-2000 and 2009-2010, compared to those carried out in 2003-2004 (global P < 0.001). Resistance testing was less common in Eastern Europe [aOR 0.72, 95% confidence interval (CI) 0.55-0.94] compared to Southern Europe, whereas the detection of resistance given that a test was done was less common in Northern (aOR 0.29, 95% CI 0.21-0.39) and Central Eastern (aOR 0.47, 95% CI 0.29-0.76) Europe, compared to Southern Europe.CONCLUSIONS: Despite a concurrent decline in virological failure and testing, drug resistance was commonly detected. This suggests a selective approach to resistance testing. The regional differences identified indicate that policy aiming to minimize the emergence of resistance is of particular relevance in some European regions, notably in the countries in Eastern Europe.

AB - OBJECTIVES: To describe regional differences and trends in resistance testing among individuals experiencing virological failure and the prevalence of detected resistance among those individuals who had a genotypic resistance test done following virological failure.DESIGN: Multinational cohort study.METHODS: Individuals in EuroSIDA with virological failure (>1 RNA measurement >500 on ART after >6 months on ART) after 1997 were included. Adjusted odds ratios (aORs) for resistance testing following virological failure and aORs for the detection of resistance among those who had a test were calculated using logistic regression with generalized estimating equations.RESULTS: Compared to 74.2% of ART-experienced individuals in 1997, only 5.1% showed evidence of virological failure in 2012. The odds of resistance testing declined after 2004 (global P < 0.001). Resistance was detected in 77.9% of the tests, NRTI resistance being most common (70.3%), followed by NNRTI (51.6%) and protease inhibitor (46.1%) resistance. The odds of detecting resistance were lower in tests done in 1997-1998, 1999-2000 and 2009-2010, compared to those carried out in 2003-2004 (global P < 0.001). Resistance testing was less common in Eastern Europe [aOR 0.72, 95% confidence interval (CI) 0.55-0.94] compared to Southern Europe, whereas the detection of resistance given that a test was done was less common in Northern (aOR 0.29, 95% CI 0.21-0.39) and Central Eastern (aOR 0.47, 95% CI 0.29-0.76) Europe, compared to Southern Europe.CONCLUSIONS: Despite a concurrent decline in virological failure and testing, drug resistance was commonly detected. This suggests a selective approach to resistance testing. The regional differences identified indicate that policy aiming to minimize the emergence of resistance is of particular relevance in some European regions, notably in the countries in Eastern Europe.

U2 - 10.1097/QAD.0000000000000708

DO - 10.1097/QAD.0000000000000708

M3 - Journal article

C2 - 26091300

VL - 29

SP - 1379

EP - 1389

JO - AIDS

JF - AIDS

SN - 0269-9370

IS - 11

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Schultze A, Phillips AN, Paredes R, Battegay M, Rockstroh JK, Machala L et al. HIV resistance testing and detected drug resistance in Europe. AIDS. 2015 Jul 17;29(11):1379-89. https://doi.org/10.1097/QAD.0000000000000708