Epidemiology of Antiretroviral Multiclass Resistance

摘要

Given the recent evolution of therapeutic trends, the frequency and determinants of multiclass-resistant HIVninfection in the modern combination highly active antiretroviral therapy (HAART) era are less well understood. Innthis study, the authors characterize the epidemiology of antiretroviral multiclass resistance among HAART-naı¨venpatients enrolled in a province-wide HAART distribution program in British Columbia, Canada. HAART and resistancentesting are free to eligible individuals in British Columbia. This study was based on patients who initiatednnaı¨ve on HAART and were followed during January 1, 2000–June 30, 2007. Explanatory logistic and survivalnmodels were built to identify those factors most influential in the emergence of multiclass resistance. Among then1,820 individuals in our study, 833 (46%) were tested for antiretroviral resistance at least once during their followup.nMulticlass resistance was observed in 142 individuals (n ?833; 17%) during a median follow-up of 14 monthsn(interquartile range, 3–34 months) (incidence rate, 0.8 cases/1,000 person-months). The authors found that initialnnonnucleoside reverse transcriptase inhibitor-based HAART was the main determinant of multiclass resistance.nGiven that these inhibitors are still widely used, priority should be given to make resistance testing and viral loadnmonitoring a standard part of human immunodeficiency virus care to maximize the long-term efficacy and efficiencynof HAART.