MDR resistance transmission increases in the UK

This study presented at Glasgow from the PHLS Unit, Birmingham, the Royal Sussex County Hospital, Brighton and the MRC Clinical Trials Unit provided an indication of the levels of transmission of drug-resistant HIV in the UK.

This study was restricted to people listed in the UK seroconverters register who had stored samples from the previous 18 months or who had seroconcerted in the previous 18 months. All people were treatment naive.

Of 69 seroconverters infected between June 1994 and August 2000, within this category, 60 were infected with sub-clade B, 3 with subtype 4, 5 with subtype C and 1 with subtype D. Ten (14%) had evidence of RT and or PR mutations associated with drug resistance including two with resistance to two classes of drugs. Amongst people seroconverting during 2000 this figure rose to 27%. All ten mutations were clade B and all patients were white (7 males infected through sex between men, 1 female needlestick injury).

Exposure category information was available for 59 individuals of whom 49 were gay men, 8 infected heterosexually and 2 through non-occupational needlestick injuries. The 8 found to have primary resistance had immediately preceding negative HIV tests in 1997 (1), 1998 (1), 1999 (5) and 2000 (1). A test for trend showed evidence of a slight increase in the risk of being infected with drug resistant virus over calendar time (RR per year = 1.97, 95% CI = 1.03 – 3.75, P = 0.04).

The authors concluded that this limited population provided clear evidence that drug resistant virus is being transmitted and that the incidence of transmission in the UK has risen since HAART became widely used.

G.L. Dean, P.A. Cane , D. Pillay et al – Incidence of transmitted anti-retroviral drug resistant HIV may be rising in the UK. In: Program and Abstracts of the Fifth International Congress on Drug Therapy in HIV Infection, October, 2000, Glasgow, Scotland. Poster 364.