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Previous Volume 347:385-394 August 8, 2002 Number 6 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Hirsch, M. S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Among persons in North America who are newly infected with the human immunodeficiency virus (HIV), the prevalence of transmitted resistance to antiretroviral drugs has been estimated at 1 to 11 percent.

Methods We performed a retrospective analysis of susceptibility to antiretroviral drugs before treatment and drug-resistance mutations in HIV in plasma samples from 377 subjects with primary HIV infection who had not yet received treatment and who were identified between May 1995 and June 2000 in 10 North American cities. Responses to treatment could be evaluated in 202 subjects.

Results Over the five-year period, the frequency of transmitted drug resistance increased significantly. The frequency of high-level resistance to one or more drugs (indicated by a value of more than 10 for the ratio of the 50 percent inhibitory concentration [IC₅₀] for the subject's virus to the IC₅₀ for a drug-sensitive reference virus) increased from 3.4 percent during the period from 1995 to 1998 to 12.4 percent during the period from 1999 to 2000 (P=0.002), and the frequency of multidrug resistance increased from 1.1 percent to 6.2 percent (P=0.01). The frequency of resistance mutations detected by sequence analysis increased from 8.0 percent to 22.7 percent (P<0.001), and the frequency of multidrug resistance detected by sequence analysis increased from 3.8 percent to 10.2 percent (P=0.05). Among subjects infected with drug-resistant virus, the time to viral suppression after the initiation of antiretroviral therapy was longer (P=0.05), and the time to virologic failure was shorter (P=0.05).

Conclusions The proportion of new HIV infections that involve drug-resistant virus is increasing in North America. Initial antiretroviral therapy is more likely to fail in patients who are infected with drug-resistant virus. Testing for resistance to drugs before therapy begins is now indicated even for recently infected patients.

Source Information

From the Departments of Medicine (S.J.L., D.D.R.) and Pathology (D.D.R.), University of California–San Diego, San Diego; the Statistical Center for HIV/AIDS Research and Prevention at the Fred Hutchinson Cancer Research Center (S.H., L.W.) and the Department of Medicine (A.C.C.), University of Washington, Seattle; the Department of Medicine, McGill University Health Center, Montreal (J.-P.R.); the Department of Medicine, Harbor–UCLA Medical Center, Torrance, Calif. (E.S.D.); the Aaron Diamond AIDS Research Center, New York (M.M.); the Vaccine Research Center, National Institutes of Health, Bethesda, Md. (R.A.K.); the Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh (J.W.M.); the Department of Medicine, University of Colorado Health Sciences Center, Denver (E.C.); the Department of Pharmacology and Medical Therapeutics, University of British Columbia, Vancouver (B.C.); the Department of Medicine, University of Alabama, Birmingham (M.K.); ViroLogic, South San Francisco, Calif. (J.M.W., N.S.H.); and the Department of Veterans Affairs San Diego Healthcare System, San Diego, Calif. (D.D.R.).

Address reprint requests to Dr. Little at the UCSD Antiviral Research Center, 150 W. Washington St., Ste. 100, San Diego, CA 92103, or at slittle{at}ucsd.edu.

Full Text of this Article

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Drug Resistance among Patients Recently Infected with HIV
Epstein B. J., Little S. J., Richman D. D.
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N Engl J Med 2002; 347:1889-1890, Dec 5, 2002. Correspondence

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