Dunn, D

Gill, J

Kran, AM Bakken

Kücherer, C

Lodi, S

Masquelier, B

Monforte, A d'Arminio

Pillay, D

Porter, K

English

PubMed

S Lodi

C Kücherer

AM Kran

B Masquelier

A Monforte

J Gill

D Dunn

D Pillay

K Porter

Springer - Publisher Connector

ORAL PRESENTATION Open Access
O114. Long-term probability of detecting drug-
resistant HIV in patients starting antiretroviral
therapy within the first year of HIV infection
S Lodi1*, C Kücherer2, AM Bakken Kran3, B Masquelier4, A d’Arminio Monforte5, J Gill6, D Dunn1, D Pillay7, K Porter1
From Tenth International Congress on Drug Therapy in HIV Infection
Glasgow, UK. 7-11 November 2010
Background
The development of drug resistance is often cited as a
disadvantage of early initiation of cART. However, little
is known about the long-term probability of detecting
drug resistance in individuals initiating cART early.
Methods
We followed-up patients in CASCADE with well-esti-
mated dates of HIV seroconversion from cART initiated
within 1 year of the first HIV positive test to the earlier
of: date of detection of drug resistance (IAS-USA list) or
last recorded VL. We included patients with a drug
resistance test following VL>1000 c/mL and those with
VL always <1000 c/mL. The latter were assumed to
have no drug resistance. Median survival from cART
initiation to detection of drug-resistance was estimated
using Kaplan-Meier methods, and log-rank tests were
used to explore the association between detection of
drug resistance and sex, risk group, cART class, as well
as age, calendar year and CD4 at cART initiation.
Results
Of 609 included patients, median (IQR) age 34 (29,42)
years and CD4 count of 364 (243,517) cells/mm3 at
cART initiation, 151 had a drug resistance test before
cART initiation of whom 7 (4.6%) had transmitted drug
resistance (TDR). 29% interrupted treatment for ≥15
days after a median of 0.86 (0.39,1.77) years. 67% and
26% initiated PI and NNRTI-containing cART, respec-
tively. Among 122 patients with at least one resistance
test, drug resistance mutation was detected in 19 with
during 2392 py follow-up (8/1000 py). Among patients
who were detected with a drug resistance mutation, 2
had TDR. The cumulative risk of drug resistance detec-
tion was 3% and 7% at 4 and 8 years after cART initia-
tion, respectively. While there was some evidence of
effect of CD4 at cART initiation (p=0.043) with higher
CD4 being associated with a decreased risk of drug
resistance detection, we found no significant association
with the other risk factors.
Conclusions
Although one third of our patients interrupted cART,
detection rate of resistance was remarkably low com-
pared to those reported in individuals initiating cART in
chronic infection. Our data do not support early cART
initiation being associated with long-term probability of
drug resistance detection.
Author details
1Clinical Trials Unit - Medical Research Council, London, UK. 2Robert Koch-
Institute, Berlin, Germany. 3Ulleval University Hospital, Oslo, Norway.
4Université Bordeaux 2, Bordeaux, France. 5San Paolo Hospital, University of
Milan, Milan, Italy. 6South Alberta HIV clinic, Calgary, Canada. 7UCL Medical
School, London, UK.
Published: 8 November 2010
doi:10.1186/1758-2652-13-S4-O4
Cite this article as: Lodi et al.: O114. Long-term probability of detecting
drug-resistant HIV in patients starting antiretroviral therapy within the
first year of HIV infection. Journal of the International AIDS Society 2010 13
(Suppl 4):O4.
1Clinical Trials Unit - Medical Research Council, London, UK
Full list of author information is available at the end of the article
Lodi et al. Journal of the International AIDS Society 2010, 13(Suppl 4):O4
http://www.jiasociety.org/content/13/S4/O4
© 2010 Lodi et al; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons
Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in
any medium, provided the original work is properly cited.


Long-term probability of detecting drug-resistant HIV in patients starting antiretroviral therapy within the first year of HIV infection

AM Bakken Kran

A d'Arminio Monforte

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Journal of the International AIDS Society

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Long-term probability of detecting drug-resistant HIV in patients starting antiretroviral therapy within the first year of HIV infection

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