Presentation Abstract

Session: 100-HIV-1 Drug Resistance
Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Presentation Title: H2-798 - Prevalence of Transmitted Drug Resistance and Its Impact on Treatment Response to First-line Highly Active Antiretroviral Therapy in Taiwan
Location: Exhibit Hall F1
Poster Board Number: 288
Presentation Number: H2-798
Pres. Time: Sunday, Sep 18, 2011, 11:15 AM - 1:15 PM
Category: H2
Keywords: transmitted drug resistance; highly active antiretroviral therapy; virologic response
Author(s): C. Lai - Attending physician1, S. Chang - Associate Professor 2, S. Chang - Research Assistant 2, Y. Su - Research Assistant 2, H. Sun - Attending Physician 3, C. Hung, MD, MSc, PhD - Assistant Professor 3;
1Kaohsiung Med. Univ. Hosp., Kaohsiung, Taiwan, 2Natl. Taiwan Univ. Coll. of Med., Taipei, Taiwan, 3Natl. Taiwan Univ. Hosp., Taipei, Taiwan.
Financial Disclosures:  C. Lai, None..
S. Chang, None..
S. Chang, None..
Y. Su, None..
H. Sun, None..
C. Hung, None.
Abstract: Background: Data on the prevalence of transmitted drug resistance (TDR) of HIV-1 and its impact on the treatment outcome are limited in the Asia-Pacific regions. Methods: Genotypic resistance assays were retrospectively performed for antiretroviral-naïve HIV-infected patients in Taiwan from 2000 to 2010. Resistance mutations were identified and interpreted using the HIVdb program of the Stanford University HIV Drug Resistance Database. The genotypic sensitivity score (GSS) of the regimen was calculated. For each case patient with low-level or higher resistance, 2 matched controls without TDR were identified. All patients was followed until April 2011 or 96 weeks after HAART. Results: Of the 1191 blood specimens, the overall prevalence of TDR to any antiretroviral agent was 8.6% (n=102), which increased from 6.6% in 2000-2003 to 12.7% in 2004-2006, and subsequently decreased to 6.5% in 2009-2010. Of 102 patients with HIV strains that harbored TDR, 45 (29 with high or intermediate-level resistance and 16 with low-level resistance) were eligible for this study, along with 85 control subjects. Compared to patients infected with HIV strains that had GSS >2.5, patients with HIV strains with GSS ≤2.5 had higher rates of treatment failure (40.7% vs 19.4%, P=0.04) and shorter time to treatment failure (P=0.002 by log rank test). Among patients with HIV strains with GSS ≤2.5, there was a trend toward a longer time to treatment failure in patients starting PI-based HAART compared with patients starting NNRTI-based (P=0.07 by log rank test). Cox proportional hazards models showed that, in patients infected with HIV strains with GSS ≤ 2.5,NNRTI-based regimens were independently associated with faster treatment failure compared with PI-based regimens (HR, 2.76; 95% CI, 1.17-6.51). Conclusions: In Taiwan, prevalence of TDR of HIV-1 strains declined and stabilized from 2000 to 2010. First-line NNRTI-based HAART was more likely to be associated with virologic failure in patients infected with HIV-1 strains with GSS ≤ 2.5 than PI-based regimens.




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