RT Journal Article
T1 Clinically Relevant Transmitted Drug Resistance to First Line Antiretroviral Drugs and Implications for Recommendations
A1 Monge, Susana
A1 Guillot, Vicente
A1 Álvarez, Marta
A1 Chueca, Natalia
A1 Stella, Natalia
A1 Peña, Alejandro
A1 Delgado, Rafael
A1 Córdoba, Juan
A1 Aguilera Guirao, Antonio
A1 Vidal, Carmen
A1 García, Federico
A1 CoRIS, 
K1 Spain
K1 Reverse transcriptase inhibitors
K1 Antiretrovirals
K1 HIV epidemiology
K1 Mutation databases
K1 Proteases
K1 HIV
K1 Protease inhibitors
AB Background: The aim was to analyse trends in clinically relevant resistance to first-line antiretroviral drugs in Spain, applying the Stanford algorithm, and to compare these results with reported Transmitted Drug Resistance (TDR) defined by the 2009 update of the WHO SDRM list. Methods: We analysed 2781 sequences from ARV naive patients of the CoRIS cohort (Spain) between 2007–2011. Using the Stanford algorithm “Low-level resistance”, “Intermediate resistance” and “High-level resistance” categories were considered as “Resistant”.Results: 70% of the TDR found using the WHO list were relevant for first-line treatment according to the Stanford algorithm. A total of 188 patients showed clinically relevant resistance to first-line ARVs [6.8% (95%Confidence Interval: 5.8–7.7)], and 221 harbored TDR using the WHO list [7.9% (6.9–9.0)]. Differences were due to a lower prevalence in clinically relevant resistance for NRTIs [2.3% (1.8–2.9) vs. 3.6% (2.9–4.3) by the WHO list] and PIs [0.8% (0.4–1.1) vs. 1.7% (1.2–2.2)], while it was higher for NNRTIs [4.6% (3.8–5.3) vs. 3.7% (3.0–4.7)]. While TDR remained stable throughout the study period, clinically relevant resistance to first line drugs showed a significant trend to a decline (p = 0.02). Conclusions: Prevalence of clinically relevant resistance to first line ARVs in Spain is decreasing, and lower than the one expected looking at TDR using the WHO list. Resistance to first-line PIs falls below 1%, so the recommendation of screening for TDR in the protease gene should be questioned in our setting. Cost-effectiveness studies need to be carried out to inform evidence-based recommendations.
PB PLOS
YR 2014
FD 2014
LK http://hdl.handle.net/10347/32041
UL http://hdl.handle.net/10347/32041
LA eng
NO Monge S, Guillot V, Alvarez M, Chueca N, Stella N, Peña A, et al. (2014) Clinically Relevant Transmitted Drug Resistance to First Line Antiretroviral Drugs and Implications for Recommendations. PLoS ONE 9(3): e90710. https://doi.org/10.1371/journal.pone.0090710
NO This work was supported by the Instituto de Salud Carlos III through the Red Temática de Investigación Cooperativa en Sida [ISCIII-RETIC RD06/006 and RD12/0017], and through Grant n° PI12/01053
DS Minerva
RD 4 may 2026