16th International HIV Drug Resistance Workshop 12-16 June 2007, Barbados

STABLE FREQUENCY OF HIV-1 TRANSMITTED DRUG RESISTANCE OVER A DECADE (1996–2006) IN FRANCE IS LIKELY EXPLAINED BY THE INCREASE OF CHRONICALLY TREATED PATIENTS IN VIROLOGICAL SUCCESS

Antivir Ther. 2007; 12:S49 (abstract no. 42)

ML Chaix ¹, J Fichou², C Deveau³, P Andre⁴, L Bocket⁵, T Bourlet⁶, D Descamps⁷, C Goujard⁸, J Izopet⁹, E Kohli¹⁰, B Masquelier¹¹, M Ouka1², C Payan¹³, I Pellegrin¹¹, JC Plantier¹⁴, S Rogez¹⁵, A Ruffault¹⁶, A Schmück¹⁷, V Schneider¹⁸, C Tamalet¹⁹, M Wirden²⁰, C Rouzioux¹, F Brun-Vezinet⁷, D Costagliola² L Meyer³ and the ANRS AC¹¹ Resistance Group, Cohort PRIMO, and FHDH Study Groups
¹CHU Necker Enfants-Malades, EA 3620, Paris, France; ² Inserm U 720, Paris, France; ³ Inserm U 569, Le Kremlin-Bicêtre, France; ⁴CHU Lyon, France; ⁵CHU Lille, France; ⁶CHU Saint-Etienne, France; ⁷CHU Bichat-Claude Bernard, Paris, France; ⁸Médecine Interne, Le Kremlin-Bicêtre, France' ⁹CHU Toulouse, France; ¹⁰CHU Dijon, France; ¹¹CHU, Bordeaux, France; ¹²CHU Fort de France, France; ¹³CHU Brest, France; ¹⁴CHU Rouen, France; ¹⁵CHU Limoges, France; ¹⁶CHU Rennes, France; ¹⁷CHU Grenoble, France; ¹⁸CHU Tenon, Paris, France; ¹⁹CHU Marseille, France; ²⁰CHU Pitié-Salpétrière, Paris, France

BACKGROUND: Transmission of drug-resistant variants is influenced by several factors, including the HIV-1 RNA levels in the population of HIV-1-infected patients and sexual behaviour of primary infected patients. Here, we analysed the evolution of transmitted resistant virus since 1996 at the time of primary infection along with the proportion of chronically infected treated patients in virological success in the French Hospital Database on HIV (FHDH) (60% of the patients in France).

METHODS: Pre-treatment plasma samples were tested for genotypic resistance in 289 patients recruited in 2005–2006. Resistance was defined according to the 2006 French resistance algorithm. Results were compared to our previous published data obtained for 1027 patients recruited at the time of PHI during 1996–2004. More than 36,000 patients were followed each year in the FHDH and the proportion of patients with viral load <500 copies/ml among patients receiving ART since >6 months was calculated.

RESULTS: In 2005–2006, 30 patients (10.4%; 95%CI: 6.9–13.9%) were infected with resistant virus to at least one antiretroviral drug; the frequency is stable since 1996. During the survey, there was no significant evolution of the frequency of resistant virus to NRTI (6%), to NNRTI (4.5%) or to PI (2%). In the FHDH, from 1996 to 2006, the proportion of patients receiving HAART increased from 38% to 81% and the proportion of viral load <500 copies/ml in treated patients increased from 16.3% in 1996 to 84.3% in 2006. Phylogenetic analysis revealed that 27% [95%CI: 22- 32%] of patients harboured HIV-1 non-B virus at the time of primary infection compared to 28% in 2003–2004, 26% in 2001–2002 and to 19% in 1999–2000. Each year, viruses of PHIs cosegregated into six to eight transmission chains with two to seven transmissions/cluster.

CONCLUSION: The frequency of acquired resistant virus at the time of primary infection was stable over time, over 5% for NRTI and NNRTI. One explanation for this stability may be the increasing number of treated patients in virological sucess. Early infection at the origin of transmission is not uncommon in French patients and successful therapy may prevent onward HIV transmission.

2007-06-12
42

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