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Clin Infect Dis. 2019 Mar 7. pii: ciz178. doi: 10.1093/cid/ciz178. [Epub ahead of print]

Emergence of drug resistance in the Swiss HIV Cohort Study under potent antiretroviral therapy is observed in socially disadvantaged patients.

Author information

1
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich.
2
Institute of Medical Virology, University of Zurich.
3
Laboratory of Virology, Division of Infectious Diseases.
4
Department of Biomedicine, University of Basel.
5
Division of Immunology and Allergy.
6
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel.
7
Department of Infectious Diseases, Bern University Hospital, University of Bern.
8
HIV/AIDS Unit, Infectious Disease Service, Geneva University Hospitals.
9
Division of Infectious Diseases, Cantonal Hospital St. Gallen.
10
Division of Infectious Diseases, Regional Hospital Lugano, Switzerland.
11
Division of Infectious Diseases, University Hospital Lausanne.

Abstract

BACKGROUND:

The rate of acquired HIV-1 drug resistance (ADR) has fallen dramatically since introduction of combined antiretroviral therapy (cART) in Switzerland. However, clinical experience indicates that there are still patients at risk of newly acquiring drug resistance despite having access to cART. Here, we characterized risk factors for ADR, in order to improve patient care, prevent emergence of drug resistance, and treatment failure.

METHODS:

We performed a case-control study to identify risk factors for ADR in all patients starting their first cART in the Swiss HIV Cohort Study (SHCS) since 1996. The SHCS is highly representative and includes over 75% of patients receiving ART in Switzerland. To this end, we implemented a systematic medical chart review to obtain more detailed information on additional parameters, which are not routinely collected in the SHCS. The collected data was analyzed univariable and multivariable conditional logistic regressions.

RESULTS:

We included in our study 115 cases and 115 matched controls. Unemployment (mOR 2.9 (95% CI: 1.3-6.4), p=0.008), African origin (mOR3.0 (95%CI: 1.0-9.2), p=0.047), co-medication with anti-infectives (mOR 3.6 (95%CI: 1.0-12.6), p=0.045) and symptoms of mental illness (mOR 2.6 (95% CI: 1.2-5.5), p=0.012) were associated with ADR in the multivariable model.

CONCLUSIONS:

Although, ADR has become very rare with cART due to new potent therapies, patients in socially challenging life situations or presenting with mental health issues are at higher risk for drug resistance. Prompt identification and adequate support of these patients before ADR will prevent treatment failure and HIV-1 transmission.

KEYWORDS:

HIV-1 drug resistance; antiretroviral therapy; risk factors; socioeconomic factors

PMID:
30843028
DOI:
10.1093/cid/ciz178

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