AIDS (London, England) · 2025
Drug resistance testing at regimen failure in individuals diagnosed with HIV-1 between 2010 and 2018 in Israel.
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Wagner Tali, Levy Itzchak, Wieder-Finesod Anat, Wax Marina, Gozlan Yael, Elbirt Daniel, Kedem Eynat, Olshtain-Pops Karen, Elinav Hila, Chowers Michal, Istomin Valery, Smolyakov Rozalia, Matus Natasha, Girshengorn Shirley, Marom Rotem, Turner Dan, Mor Orna
Аннотация
OBJECTIVE: Assess virological failures, analyze the results of resistance testing (RET), and investigate factors associated with acquired drug resistance mutations (aDRM).
DESIGN: A retrospective longitudinal cohort study.
METHODS: Virological failures (viral load >50 copies/ml) from a cohort of 1130 individuals, diagnosed with HIV-1 in 2010-2018 and followed up until 2020, were included. Demographic, clinical, and virological data were collected. A piecewise exponential additive mixed model was employed to estimate the association of various factors with aDRM.
RESULTS: Only 82 individuals had virological failure, 20/82 had multiple virological failures. The majority of virological failures (77%) were men, 48% were Israeli-born,79% were diagnosed in 2010-2014. Only 18% initiated with second-generation integrase-inhibitor (INI) based regimens. Although no baseline differences were identified between those with single and multiple virological failures, the latter had lower CD4 + levels before first virological failure. NRTI M184IV and INI N155H were identified in more than 10% of the cases. In those with additional failures, INI N155H was more prominent in cases with subtype B compared to those with non-B subtypes ( P = 0.039). Diagnoses with CD4 + cell count less than 200 cells/μl and AIDS [hazard ratio = 3.46, 95% confidence interval (95% CI): 1.51-7.92, P = 0.003], second-generation INI at the first virological failure (HR = 0.32, 95% CI: 0.11-0.91, P = 0.033), and RET at baseline (hazard ratio = 0.34, 95% CI: 0.13-0.86, P = 0.022) had a significant and persistent relative effect on aDRM.
CONCLUSION: The risk for aDRM is reduced in those who are treated with second-generation INI-based regimens. Diagnosis with low CD4 + cell counts and AIDS is associated with detection of aDRM.
DESIGN: A retrospective longitudinal cohort study.
METHODS: Virological failures (viral load >50 copies/ml) from a cohort of 1130 individuals, diagnosed with HIV-1 in 2010-2018 and followed up until 2020, were included. Demographic, clinical, and virological data were collected. A piecewise exponential additive mixed model was employed to estimate the association of various factors with aDRM.
RESULTS: Only 82 individuals had virological failure, 20/82 had multiple virological failures. The majority of virological failures (77%) were men, 48% were Israeli-born,79% were diagnosed in 2010-2014. Only 18% initiated with second-generation integrase-inhibitor (INI) based regimens. Although no baseline differences were identified between those with single and multiple virological failures, the latter had lower CD4 + levels before first virological failure. NRTI M184IV and INI N155H were identified in more than 10% of the cases. In those with additional failures, INI N155H was more prominent in cases with subtype B compared to those with non-B subtypes ( P = 0.039). Diagnoses with CD4 + cell count less than 200 cells/μl and AIDS [hazard ratio = 3.46, 95% confidence interval (95% CI): 1.51-7.92, P = 0.003], second-generation INI at the first virological failure (HR = 0.32, 95% CI: 0.11-0.91, P = 0.033), and RET at baseline (hazard ratio = 0.34, 95% CI: 0.13-0.86, P = 0.022) had a significant and persistent relative effect on aDRM.
CONCLUSION: The risk for aDRM is reduced in those who are treated with second-generation INI-based regimens. Diagnosis with low CD4 + cell counts and AIDS is associated with detection of aDRM.