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Oxford University Press (OUP), The Journal of Infectious Diseases, 6(192), p. 958-966

DOI: 10.1086/432916

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Prevalence of Drug‐Resistant HIV‐1 Variants in Untreated Individuals in Europe: Implications for Clinical Management

This paper is made freely available by the publisher.
This paper is made freely available by the publisher.

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Abstract

Background. Infection with drug-resistant human immunodeficiency virus type 1 (HIV-1) can impair the response to combination therapy. Widespread transmission of drug-resistant variants has the disturbing potential of limiting future therapy options and affecting the efficacy of postexposure prophylaxis. Methods. We determined the baseline rate of drug resistance in 2208 therapy-naive patients recently and chronically infected with HIV-1 from 19 European countries during 1996–2002. Results. In Europe, 1 of 10 antiretroviral-naive patients carried viruses with 1 drug-resistance mutation. Recently infected patients harbored resistant variants more often than did chronically infected patients (13.5% vs. 8.7%; Pp.006). Non-B viruses (30%) less frequently carried resistance mutations than did subtype B viruses (4.8% vs. 12.9%; P ! .01). Baseline resistance increased over time in newly diagnosed cases of non-B infection: from 2.0% (1/49) in 1996–1998 to 8.2% (16/194) in 2000–2001. Conclusions. Drug-resistant variants are frequently present in both recently and chronically infected therapynaive patients. Drug-resistant variants are most commonly seen in patients infected with subtype B virus, probably because of longer exposure of these viruses to drugs. However, an increase in baseline resistance in non-B viruses is observed. These data argue for testing all drug-naive patients and are of relevance when guidelines for management of postexposure prophylaxis and first-line therapy are updated.