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 (2019). Emergence of drug resistance in the Swiss HIV Cohort Study under potent antiretroviral therapy is observed in socially disadvantaged patients. (In Press). Clinical infectious diseases Oxford University Press 10.1093/cid/ciz178

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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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Haematology, Oncology, Infectious Diseases, Laboratory Medicine and Hospital Pharmacy (DOLS) > Clinic of Infectiology

UniBE Contributor:

Furrer, Hansjakob

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1537-6591

Publisher:

Oxford University Press

Language:

English

Submitter:

Annelies Luginbühl

Date Deposited:

23 May 2019 16:52

Last Modified:

23 Oct 2019 12:07

Publisher DOI:

10.1093/cid/ciz178

PubMed ID:

30843028

Uncontrolled Keywords:

HIV-1 drug resistance antiretroviral therapy risk factors socioeconomic factors

BORIS DOI:

10.7892/boris.127858

URI:

https://boris.unibe.ch/id/eprint/127858

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