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Marked decrease in acquired resistance to antiretrovirals in latest years in Italy.

Alessia Lai1, Marco Franzetti2, Annalisa Bergna1

  • 1Department of Biomedical and Clinical Sciences 'L. Sacco', University of Milan, Milan, Italy.

Clinical Microbiology and Infection : the Official Publication of the European Society of Clinical Microbiology and Infectious Diseases
|September 26, 2020
PubMed
Summary
This summary is machine-generated.

Over a decade, HIV drug resistance significantly decreased in Italy, attributed to more potent antiretrovirals. However, challenges persist for non-B subtypes due to protease region complexities.

Keywords:
ART regimensAcquired resistanceAntiretroviralsPredictors of resistanceTemporal trends

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Area of Science:

  • Infectious Diseases
  • Virology
  • Pharmacology

Background:

  • Antiretroviral therapy (ART) has transformed HIV management, but acquired drug resistance remains a significant clinical challenge.
  • Monitoring trends in drug resistance is crucial for optimizing treatment strategies and public health interventions.

Purpose of the Study:

  • To evaluate the trends and characteristics of acquired drug resistance in patients with HIV-1 infection in Italy between 2009 and 2018.
  • To assess the impact of newer antiretroviral drugs on resistance patterns.

Main Methods:

  • Analysis of 3094 patients from the Italian ARCA database with documented virologic failure after at least 6 months of ART.
  • Genotypic resistance testing interpreted using International AIDS Society (IAS)-USA mutation lists and the Stanford HIVdb algorithm.
  • Statistical analysis of time trends and factors associated with drug resistance.

Main Results:

  • Acquired resistance to any antiretroviral drug class, including nucleoside reverse transcriptase inhibitors, non-nucleoside reverse transcriptase inhibitors, and protease inhibitors, significantly declined.
  • Integrase strand transfer inhibitor resistance showed a significant decrease according to the Stanford HIVdb algorithm, but not the IAS-USA tables.
  • Patients of non-European origin and those infected with non-B HIV subtypes showed an increasing prevalence over the study period.

Conclusions:

  • A substantial reduction in HIV drug resistance was observed over ten years, likely due to the increased genetic barrier and potency of newer antiretroviral agents.
  • Discrepancies between interpretation systems (IAS-USA vs. Stanford HIVdb) highlight challenges in resistance assessment for non-B subtypes.
  • Continued surveillance and refined interpretation algorithms are necessary to address evolving resistance patterns, particularly in diverse patient populations.