Time trends in primary resistance to HIV drugs in the United Kingdom: multicentre observational study

doi:10.1136/bmj.38665.534595.55

BMJ, doi: 10.1136/bmj.38665.534595.55, (Published 18 November 2005)

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Time trends in primary resistance to HIV drugs in the United Kingdom: multicentre observational study

UK Group on Transmitted HIV Drug Resistance David Dunn ¹^*

¹ Medical Research Centre Clinical Trials Unit, London NW1 2DA

^* Correspondence to: d.dunn{at}ctu.mrc.ac.uk.

Objective To examine whether the level of primary resistanceto HIV drugs is increasing in the United Kingdom.

Design Multicentreobservational study.

Setting All virology laboratories in theUnited Kingdom carrying out tests for HIV resistance as partof routine clinical care.

Participants 2357 people infected withHIV who were tested for resistance before receiving antiretroviraltherapy.

Main outcome measure Prevalence of drug resistance onbasis of the Stanford genotypic interpretation system.

ResultsOver the study period (February 1996 to May 2003), 335 (14.2%,95% confidence interval 12.8% to 15.7%) samples had mutationsthat conferred resistance to one or more antiretroviral drugs(9.3% high level resistance, 5.9% medium level resistance).The prevalence of primary resistance has increased markedlyover time, although patterns are specific to drug class; thelargest increase was for non-nucleoside reverse transcriptaseinhibitors. In 2002-3, the prevalence of resistance to any antiretroviraldrug to nucleoside or nucleotide reverse transcriptase inhibitors,to non-nucleoside reverse transcriptase inhibitors, or to proteaseinhibitors was 19.2% (15.7% to 23.2%), 12.4% (9.5% to 15.9%),8.1% (5.8% to 11.1%), and 6.6% (4.4% to 9.3%), respectively.The risk of primary resistance was only weakly related to mostdemographic and clinical factors, including ethnicity and viralsubtype.

Conclusions The United Kingdom has one of the highestreported rates of primary resistance to HIV drugs worldwide.Prevalence seems still to be increasing and is high in all demographicsubgroups.

(Accepted 27 September 2005)

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