HIV-1 transmitted drug resistance between 2014-2020 in a HIV large population in Brighton, UK

ABSTRACT

Background HIV-1 transmitted drug resistance (TDR) is associated with sexually transmitted infections (STIs) and sexual clusters including MSM and non-MSM. TDR can lead to antiretroviral failure, and therefore UK guidelines recommend TDR testing in all new HIV patients. Subtype B is most common in urbanised western populations however is decreasing in proportion. Within the UK TDR is estimated to be 7.5% and non-B subtype 51%. Methods Using the WHO TDR list, we aimed to determine from our clinic database;the prevalence of TDR, non-B subtype and associated features in our large tertiary HIV department (∼2500 patients) from 2014-2020. Results Of the 218 new diagnoses, 217 had a resistance test attempted (1 stored due to COVID-19). 212/217 had an available genotype (5 failed to amplify).. 191/212(90%) were MSM, 12/212(6%) cis-female, 80/212(38%) non-UK born and the median age was 36 years (IQR=29-46). The overall prevalence of TDR was 17/212(8%;95%CI=5.0-12.4), seven (3%) had a NRTI mutation, six (3%) had at least one nNRTI mutation and 4(2%) had a PI mutation. There were no dual/triple class/INI mutations. There was no significant change in the prevalence of TDR over the study period. The overall prevalence of non-B subtype was 53/212(25%;95% CI=19.6-31.2), and was not more frequently seen in non- UK born individuals (OR=1.24;CI=0.66-2.33,p=0.51). Patients with TDR were older [45.v.36 years, p=0.006] and have non-B subtype (OR=2.96;CI=1.08-8.13,p=0.03). Although overall rates of bacterial STIs was high (34%), having a bacterial STI was not associated with TDR (OR=1.77;95%CI=0.66-4.82,p=0.26). Conclusion TDR is associated with age and non-B subtype in our population. HIV TDR is not decreasing locally and remains a small but significant concern despite effective HIV prevention strategies, which may not reach hidden populations affected by HIV. Continued efforts to reduce HIV transmission must target hidden populations and we must maintain adequate surveillance of TDR.