Abstract BACKGROUND: An increase in pretreatment drug resistance (PDR) to first-line antiretroviral therapy (ART) in low-income countries has been recently described. Herein we analyze the prevalence of PDR and risk of virologic failure (VF) over time among migrants to Italy enrolled in ARCA. METHODS: HIV-1 sequences from ART-naïve patients of non-Italian-nationality were retrieved from ARCA database from 1998 to 2017. PDR was defined by at least one mutation from the reference 2009-WHO-surveillance-list. RESULTS: Protease/reverse-transcriptase sequences from 1,155 patients, mainly migrants from Sub-Saharan Africa (SSA) (42%), followed by Latin America (LA) (25%) and Western Countries (WE) (21%), were included. PDR was detected in 8.6% of sequences (13.1% vs 5.8% for B and non-B strains, respectively, p<0.001). 2.1% of patients carried a PDR for protease inhibitors (PIs) (2.1% vs 2.3%, p=0.893), 3.9% for nucleos(t)ide-reverse-transcriptase inhibitors (NRTI) (6.8% vs 2.1%, p<0.001) and 4.3% for non-nucleos(t)ide-reverse-transcriptase inhibitors (NNRTI) (6.3% vs 3.1%, p=0.013). Overall, prevalence of PDR over the years remained stable, while it decreased for PIs in LA (p=0.021), and for NRTI (p=0.020) among migrants from WE. Having more than 1 class of PDR (p=0.015 vs. absence of PDR), higher viral load at diagnosis (p=0.008) and being migrants from SSA (p=0.001 vs. WE) were predictive of VF, while a recent calendar year of diagnosis (p<0.001) was protective for VF. CONCLUSIONS: PDR appeared to be stable over the years in migrants to Italy enrolled in ARCA; however, it still remains an important cause of VF together with VL at diagnosis.

Bavaro, D. F., Di Carlo, D., Rossetti, B., Bruzzone, B., Vicenti, I., Pontali, E., Zoncada, A., Lombardi, F., Di Giambenedetto, S., Borghi, V., Pecorari, M., Milini, P., Meraviglia, P., Monno, L., Saracino, A., Pretreatment HIV drug resistance and treatment failure in non-Italian HIV-1-infected patients enrolled in ARCA, <<ANTIVIRAL THERAPY>>, 2020; (na): N/A-N/A. [doi:10.3851/IMP3349] [http://hdl.handle.net/10807/147502]

Pretreatment HIV drug resistance and treatment failure in non-Italian HIV-1-infected patients enrolled in ARCA

Rossetti, Barbara;Lombardi, Francesca;Di Giambenedetto, Simona;
2020

Abstract

Abstract BACKGROUND: An increase in pretreatment drug resistance (PDR) to first-line antiretroviral therapy (ART) in low-income countries has been recently described. Herein we analyze the prevalence of PDR and risk of virologic failure (VF) over time among migrants to Italy enrolled in ARCA. METHODS: HIV-1 sequences from ART-naïve patients of non-Italian-nationality were retrieved from ARCA database from 1998 to 2017. PDR was defined by at least one mutation from the reference 2009-WHO-surveillance-list. RESULTS: Protease/reverse-transcriptase sequences from 1,155 patients, mainly migrants from Sub-Saharan Africa (SSA) (42%), followed by Latin America (LA) (25%) and Western Countries (WE) (21%), were included. PDR was detected in 8.6% of sequences (13.1% vs 5.8% for B and non-B strains, respectively, p<0.001). 2.1% of patients carried a PDR for protease inhibitors (PIs) (2.1% vs 2.3%, p=0.893), 3.9% for nucleos(t)ide-reverse-transcriptase inhibitors (NRTI) (6.8% vs 2.1%, p<0.001) and 4.3% for non-nucleos(t)ide-reverse-transcriptase inhibitors (NNRTI) (6.3% vs 3.1%, p=0.013). Overall, prevalence of PDR over the years remained stable, while it decreased for PIs in LA (p=0.021), and for NRTI (p=0.020) among migrants from WE. Having more than 1 class of PDR (p=0.015 vs. absence of PDR), higher viral load at diagnosis (p=0.008) and being migrants from SSA (p=0.001 vs. WE) were predictive of VF, while a recent calendar year of diagnosis (p<0.001) was protective for VF. CONCLUSIONS: PDR appeared to be stable over the years in migrants to Italy enrolled in ARCA; however, it still remains an important cause of VF together with VL at diagnosis.
Inglese
Bavaro, D. F., Di Carlo, D., Rossetti, B., Bruzzone, B., Vicenti, I., Pontali, E., Zoncada, A., Lombardi, F., Di Giambenedetto, S., Borghi, V., Pecorari, M., Milini, P., Meraviglia, P., Monno, L., Saracino, A., Pretreatment HIV drug resistance and treatment failure in non-Italian HIV-1-infected patients enrolled in ARCA, <<ANTIVIRAL THERAPY>>, 2020; (na): N/A-N/A. [doi:10.3851/IMP3349] [http://hdl.handle.net/10807/147502]
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