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PLoS One. 2013;8(3):e59337. doi: 10.1371/journal.pone.0059337. Epub 2013 Mar 22.

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

Author information

1
Department of Medicine, Karolinska Institutet Huddinge, Stockholm, Sweden. irene.bontell@ki.se

Abstract

OBJECTIVE:

Describe trends in antiretroviral treatments and drug resistance mutations among Swedish HIV-patients over time 1997-2011.

METHODS:

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.

RESULTS:

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.

CONCLUSIONS:

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.

PMID:
23533618
PMCID:
PMC3606434
DOI:
10.1371/journal.pone.0059337
[Indexed for MEDLINE]
Free PMC Article

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