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


Abela, Irene A; Scherrer, Alexandra U; Böni, Jürg; Yerly, Sabine; Klimkait, Thomas; Perreau, Matthieu; Hirsch, Hans H; Furrer, Hansjakob; Calmy, Alexandra; Schmid, Patrick; Cavassini, Matthias; Bernasconi, Enos; Günthard, Huldrych F; Swiss HIV Cohort Study (2019). Emergence of drug resistance in the Swiss HIV Cohort Study under potent antiretroviral therapy is observed in socially disadvantaged patients. Clinical Infectious Diseases:Epub ahead of print.

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.

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.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Infectious Diseases
Dewey Decimal Classification:610 Medicine & health
Language:English
Date:7 March 2019
Deposited On:09 Aug 2019 08:05
Last Modified:01 Oct 2019 11:38
Publisher:Oxford University Press
ISSN:1058-4838
OA Status:Closed
Free access at:Publisher DOI. An embargo period may apply.
Publisher DOI:https://doi.org/10.1093/cid/ciz178
PubMed ID:30843028

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