Emergence of drug resistance in the Swiss HIV Cohort Study under potent antiretroviral therapy is observed in socially disadvantaged patients. Â Clinical Infectious Disease
In the Swiss HIV Cohort Study, the rate of acquired drug resistance (ADR) has fallen dramatically since introduction of combined antiretroviral therapy (ART). To further identify, why some people still fail ART respectively develop ADR, Abela et al. systematically characterized risk factors for ADR, in order to improve patient care, prevent emergence of drug resistance, and treatment failure.
For this, they performed a case-control study to identify risk factors for ADR in all patients starting their first cART in the Swiss HIV Cohort Study (SHCS) since 1996. The SHCS is highly representative and includes over 75% of patients receiving ART in Switzerland. To this end, they implemented a systematic medical chart review to obtain more detailed information on additional parameters, which are not routinely collected in the SHCS.
The collected data was analyzed by univariable and multivariable conditional logistic regressions. They included 115 cases and 115 matched controls. Unemployment (multivariable odds ratio (mOR) 2.9 [95% CI: 1.3-6.4], p=0.008), African origin (mOR 3.0 [95%CI: 1.0-9.2], p=0.047), co-medication with anti-infectives (mOR 3.7 [95%CI: 1.0-12.6], p=0.045) and symptoms of mental illness (mOR 2.6 [95% CI: 1.2-5.5], p=0.012) were associated with ADR in the multivariable model. Only four of 115 cases did not have any risk factor identified in this study with the emergence of drug resistance.
Although ADR has become very rare with cART due to new potent therapies, patients in socially challenging life situations or presenting with mental health issues are at higher risk for drug resistance. Prompt identification and adequate support of these patients before ADR will prevent treatment failure and HIV-1 transmission.