July 2006

Literature Review

Tracking the prevalence of transmitted antiretroviral drug-resistant HIV-1: A decade of experience
Go to full text in PubMed: Shet A, Berry L, Mohri H, et al.; J Acquir Immune Defic Syndr 2006;41:439

This is a report from Aaron Diamond AIDS Research Center summarizing the results of resistance testing of HIV-strains among patients with recent infections treated at their institution from 1995 through 2004. The analysis show the prevalence of transmitted resistance increased from 13.2% during the period 1995-98 to 24.1% in 2003-04. The results by year of analysis, category of drug and predominant resistance mutations is summarized in the following table:

*RT: TAMS - 15, 184V - 0, 65R - 0, 103N - 3, 181C - 4
PI: 90M - 7, 82A - 2, 84V - 2

The authors note that of the 112 treatment-naive subjects enrolled in 2003-04, there were 73 (65%) who had treatment initiated and had complete treatment records. All of these patients had acute or recent HIV infection as a criterion for inclusion in the analysis of resistance. The review of the antiretroviral regimen given was considered appropriate according to the resistance profile. Further, the median time to viral suppression to <50 c/ml averaged 112 days for those with wild-type virus compared to 114 days for those with drug-resistant strains. The authors conclude that their results "reinforce the need for baseline resistance testing in acute and early HIV-1 infection."

Commentary: Transmission of drug-resistant strains increased from 1995 to 1999-2000 which was anticipated, but it subsequently has slowed according to studies from Europe [Chaix ML, Descamps D, Harzic M, et al. AIDS 2003;17:2635; Bezemer D, Jurriaans S, Prins M, et al. AIDS 2004;18:1571], and Australia [Ammaranond P, Cunningham P, Oelrichs R, et al. AIDS 2003;17:264] and the US [Grant RM, Hecht FM, Warmerdam M, et al. JAMA 2002;288:181]. It might be noted that baseline resistance testing is now included in the May 4, 2006 edition of the DHHS guidelines for antiretroviral drugs in adults and adolescents.

Literature Review by John G. Barlett, M.D. Professor, Division of Infectious Diseases

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