Disclosures: McClung reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

July 20, 2021
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Prevalence of transmitted resistance to common HIV drugs remains stable

Disclosures: McClung reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.

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The prevalence of transmitted resistance to common HIV drugs in the United States remained stable between 2014 and 2018, according to a study published recently in Clinical Infectious Diseases.

“In the United States, all states and territories submit deidentified demographic, risk, clinical and laboratory data for persons with diagnosed HIV infection to the National HIV Surveillance System (NHSS) at the CDC. This includes nucleotide sequence data from drug resistance testing,” R. Paul McClung, MD, a lieutenant commander in the U.S. Public Health Service and medical epidemiologist at the CDC, told Healio.

Source: Adobe Stock
The prevalence of transmitted resistance to coming HIV drugs has remained stable in the United States. Source: Shutterstock

“These data provide valuable insight into population-level drug resistance patterns and can inform clinical guidelines for the management of HIV and PrEP,” McClung said. “This study analyzed NHSS data to describe the prevalence of transmitted drug resistance in the United States among people with HIV diagnosed [from] 2014 to 2018.”

For their study, McClung and colleagues assessed the prevalence of transmitted drug resistance-associated mutations (TDRM) and predicted susceptibility to common HIV drugs among people living with HIV in the U.S. who were diagnosed between 2014 and 2018.

All participants had a drug resistance test performed 3 or fewer months after HIV diagnosis that was reported to the NHSS and resided in 28 U.S. jurisdictions where 20% or more of HIV diagnoses had an eligible sequence during this period.

McClung explained that the study provided an updated look at transmitted drug resistance for non-nucleoside reverse transcriptase inhibitors, nucleoside reverse transcriptase inhibitors, and protease inhibitors. In a first, it also included the prevalence of transmitted resistance to integrase strand transfer inhibitors (INSTIs) from a large sample.

Overall, the study found that TDRM prevalence overall and for individual drug classes remained did not increase or decrease between 2014 and 2018, the researchers reported.

According to their findings, among the 50,747 people included in the analysis, 18.9% had one or more TDRMs. The prevalence was 0.8% for INSTIs, 4.2% for protease inhibitors, 6.9% for nucleoside reverse transcriptase inhibitors and 12% for non-nucleoside reverse transcriptase inhibitors.

Additionally, the study demonstrated that most individual mutations had a prevalence of less than 1%, including M184V and K65R, which have been associated with PrEP failure, whereas K103N, a mutation that substantially reduces the efficacy of efavirenz — a drug previously used in first-line ART — was by far the most common mutation.

“Standard genotypic drug resistance testing is recommended at entry into care for everyone with HIV in the U.S. to assist with selection of an initial ART regimen. This study confirms that transmitted resistance to current first-line ART is low, and it supports current ART and PrEP recommendations,” McClung said. “Amid evolving trends in the use of these drugs, population-level monitoring remains essential for informing current and future treatment and prevention guidelines.”