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Article

Increasing Prevalence of HIV-1 Transmitted Drug Resistance in Portugal: Implications for First Line Treatment Recommendations

1
Global Health and Tropical Medicine (GHTM), Instituto de Higiene e Medicina Tropical/Universidade Nova de Lisboa (IHMT/UNL), 1349–028 Lisbon, Portugal
2
Laboratório de Biologia Molecular (LMCBM, SPC, CHLO-HEM), 1349-019 Lisbon, Portugal
3
Department of Microbiology and Immunology, KU Leuven, Clinical and Epidemiological Virology, Rega Institute for Medical Research, 3000 Leuven, Belgium
4
Artificial Intelligence Lab, Department of computer science, Vrije Universiteit Brussel, 1000 Brussels, Belgium
5
Interuniversity Institute of Biostatistics and statistical Bioinformatics, Data Science Institute, Hasselt University, 3500 Hasselt, Belgium
6
Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, 2829-511 Caparica, Portugal
*
Author to whom correspondence should be addressed.
Membership of the Portuguese HIV-1 Resistance Study Group is provided in the Acknowledgements
Viruses 2020, 12(11), 1238; https://doi.org/10.3390/v12111238
Received: 5 September 2020 / Revised: 27 October 2020 / Accepted: 29 October 2020 / Published: 30 October 2020
(This article belongs to the Special Issue HIV Molecular Epidemiology for Prevention 2020)
Introduction: Treatment for All recommendations have allowed access to antiretroviral (ARV) treatment for an increasing number of patients. This minimizes the transmission of infection but can potentiate the risk of transmitted (TDR) and acquired drug resistance (ADR). Objective: To study the trends of TDR and ADR in patients followed up in Portuguese hospitals between 2001 and 2017. Methods: In total, 11,911 patients of the Portuguese REGA database were included. TDR was defined as the presence of one or more surveillance drug resistance mutation according to the WHO surveillance list. Genotypic resistance to ARV was evaluated with Stanford HIVdb v7.0. Patterns of TDR, ADR and the prevalence of mutations over time were analyzed using logistic regression. Results and Discussion: The prevalence of TDR increased from 7.9% in 2003 to 13.1% in 2017 (p < 0.001). This was due to a significant increase in both resistance to nucleotide reverse transcriptase inhibitors (NRTIs) and non-nucleotide reverse transcriptase inhibitors (NNRTIs), from 5.6% to 6.7% (p = 0.002) and 2.9% to 8.9% (p < 0.001), respectively. TDR was associated with infection with subtype B, and with lower viral load levels (p < 0.05). The prevalence of ADR declined from 86.6% in 2001 to 51.0% in 2017 (p < 0.001), caused by decreasing drug resistance to all antiretroviral (ARV) classes (p < 0.001). Conclusions: While ADR has been decreasing since 2001, TDR has been increasing, reaching a value of 13.1% by the end of 2017. It is urgently necessary to develop public health programs to monitor the levels and patterns of TDR in newly diagnosed patients. View Full-Text
Keywords: HIV-1; transmitted drug resistance; acquired drug resistance; Portugal HIV-1; transmitted drug resistance; acquired drug resistance; Portugal
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MDPI and ACS Style

Pingarilho, M.; Pimentel, V.; Diogo, I.; Fernandes, S.; Miranda, M.; Pineda-Pena, A.; Libin, P.; Theys, K.; O. Martins, M.R.; Vandamme, A.-M.; Camacho, R.; Gomes, P.; Abecasis, A.; on behalf of the Portuguese HIV-1 Resistance Study Group. Increasing Prevalence of HIV-1 Transmitted Drug Resistance in Portugal: Implications for First Line Treatment Recommendations. Viruses 2020, 12, 1238. https://doi.org/10.3390/v12111238

AMA Style

Pingarilho M, Pimentel V, Diogo I, Fernandes S, Miranda M, Pineda-Pena A, Libin P, Theys K, O. Martins MR, Vandamme A-M, Camacho R, Gomes P, Abecasis A, on behalf of the Portuguese HIV-1 Resistance Study Group. Increasing Prevalence of HIV-1 Transmitted Drug Resistance in Portugal: Implications for First Line Treatment Recommendations. Viruses. 2020; 12(11):1238. https://doi.org/10.3390/v12111238

Chicago/Turabian Style

Pingarilho, Marta, Victor Pimentel, Isabel Diogo, Sandra Fernandes, Mafalda Miranda, Andrea Pineda-Pena, Pieter Libin, Kristof Theys, M. R. O. Martins, Anne-Mieke Vandamme, Ricardo Camacho, Perpétua Gomes, Ana Abecasis, and on behalf of the Portuguese HIV-1 Resistance Study Group. 2020. "Increasing Prevalence of HIV-1 Transmitted Drug Resistance in Portugal: Implications for First Line Treatment Recommendations" Viruses 12, no. 11: 1238. https://doi.org/10.3390/v12111238

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