Trends and Predictors of Transmitted Drug Resistance (TDR) and Clusters with TDR in a Local Belgian HIV-1 Epidemic
Creators: name: Pineda-Peña, Andrea-Clemencia
name: Schrooten, Yoeri
name: Vinken, Lore
name: Ferreira, Fossie
name: Li, Guangdi
name: Trovão, Nídia Sequeira
name: Khouri, Ricardo
name: Derdelinckx, Inge
name: Munter, Paul De
name: Kücherer, Claudia
name: Kostrikis, Leondios G.
name: Nielsen, Claus
name: Littsola, Kirsi
name: Wensing, Annemarie
name: Stanojevic, Maja
name: Paredes, Roger
name: Balotta, Claudia
name: Albert, Jan
name: Boucher, Charles
name: Gomez-Lopez, Arley
name: Wijngaerden, Eric Van
name: Ranst, Marc Van
name: Vercauteren, Jurgen
name: Vandamme, Anne-Mieke
name: Laethem, Kristel Van
Publisher: name: Robert Koch-Institut, Infektionskrankheiten / Erreger
Year: 2014
Subjects: subject: Humans
subject: Female
subject: Male
subject: Adult
subject: Aged
subject: Middle Aged
subject: Risk Factors
subject: Young Adult
subject: Anti-HIV Agents/therapeutic use
subject: HIV Infections/epidemiology
subject: HIV Infections/virology
subject: Prevalence
subject: Genotype
subject: Cluster Analysis
subject: HIV-1/genetics
subject: Retrospective Studies
subject: HIV Infections/drug therapy
subject: HIV-1/drug effects
subject: Public Health Surveillance
subject: Microbial Sensitivity Tests
subject: HIV Infections/transmission
subject: Drug Resistance Viral/genetics
subject: Anti-HIV Agents/pharmacology
subject: Belgium/epidemiology
subject: Pregnancy
subject: 610 Medizin

description: We aimed to study epidemic trends and predictors for transmitted drug resistance (TDR) in our region, its clinical impact and its association with transmission clusters. We included 778 patients from the AIDS Reference Center in Leuven (Belgium) diagnosed from 1998 to 2012. Resistance testing was performed using population-based sequencing and TDR was estimated using the WHO-2009 surveillance list. Phylogenetic analysis was performed using maximum likelihood and Bayesian techniques. The cohort was predominantly Belgian (58.4%), men who have sex with men (MSM) (42.8%), and chronically infected (86.5%). The overall TDR prevalence was 9.6% (95% confidence interval (CI): 7.7–11.9), 6.5% (CI: 5.0–8.5) for nucleoside reverse transcriptase inhibitors (NRTI), 2.2% (CI: 1.4–3.5) for non-NRTI (NNRTI), and 2.2% (CI: 1.4–3.5) for protease inhibitors. A significant parabolic trend of NNRTI-TDR was found (p = 0.019). Factors significantly associated with TDR in univariate analysis were male gender, Belgian origin, MSM, recent infection, transmission clusters and subtype B, while multivariate and Bayesian network analysis singled out subtype B as the most predictive factor of TDR. Subtype B was related with transmission clusters with TDR that included 42.6% of the TDR patients. Thanks to resistance testing, 83% of the patients with TDR who started therapy had undetectable viral load whereas half of the patients would likely have received a suboptimal therapy without this test. In conclusion, TDR remained stable and a NNRTI up-and-down trend was observed. While the presence of clusters with TDR is worrying, we could not identify an independent, non-sequence based predictor for TDR or transmission clusters with TDR that could help with guidelines or public health measures.