HIV drug resistance is increasing in the UK

Analysis of prevalence of HIV-1 drug resistance in primary infections in the United Kingdom

Editorial: Is transmitted drug resistance in HIV on the rise?

The prevalence of transmitted HIV drug resistance in the United Kingdom is increasing, according to a study in this week's BMJ. This finding emphasises the urgent need for new approaches to encourage safer sexual behaviour.

A total of 69 patients infected with HIV between June 1994 and August 2000 were evaluated for resistance within 18 months of their infection. Participants had received no antiretroviral drugs at the time of resistance testing. Drug resistance was defined as the presence of one or more key HIV-1 mutations associated with drug resistance.

Resistance was detected in 10 (14%) of patients. In two of the 10 cases, resistance against two of the three available classes of antiretroviral agents was identified. The risk of being infected with drug resistant virus increased over time, with an estimated prevalence of 27% in people infected in 2000.

Methods to improve drug adherence in people receiving antiretroviral therapy, together with evaluation of the impact of drug resistance and new approaches to encourage safer sexual behaviour, are urgently needed conclude the authors. They also suggest that the impact of transmission of resistance on subsequent treatment response requires full evaluation.

These views are reiterated in an accompanying editorial by Susan Little, Assistant Professor of Medicine at the University of California. She writes: "Drug resistance testing in all recently infected individuals is needed to monitor changes in the prevalence of transmitted drug resistance among different risk groups and to optimise initial treatment choices."

Contacts:

[Paper]: Simon Gregor, PHLS Communications Unit, London, UK

or Deenan Pillay, PHLS Antiviral Susceptibility Reference Unit, University of Birmingham Medical School, Birmingham, UK Email: d.pillay@bham.ac.uk

[Editorial]: Susan Little, Assistant Professor of Medicine, University of California Department of Medicine, San Diego, California, USA Email: slittle@ucsd.edu