Federico García H. U. San Cecilio, Granada [email protected]Evaluation of Transmitted Drug Resistance (TDR): Comparison of two different approaches and implications for recommendations. S. Monge 1 , V. Guillot 2 , M. Alvarez 2 , L. Anta 3 , S. García-Bujalance 4 , A. Peña 2 , J.A. Iribarren 5 , M. Masiá 6 , J.R. Blanco 7 , F. Garcia 2 . O_06
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Evaluation of Transmitted Drug Resistance (TDR): Comparison of …regist2.virology-education.com/2013/11EU/docs/08_Garcia.pdf · 2013. 3. 22. · Global prevalence of Transmitted
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Transmitted Drug Resistance currently evaluated by WHO List, Bennett et al PlosOne 2009.
Evaluates TDR to a whole class, based on a single mutation.
Resistance to PIs seems to be affected by natural non-B polymorphisms, Frentz et al JAIDS 2011
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Background
WHO List, does not: give information on individual drugs take into account the genetic barrier of drugs give information on the therapeutic barrier of a
regimen
WHO list information may not be clinically relevant
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Aim
To compare two different approaches to evaluate TDR To evaluate differences in implications for
clinical recommendations
Patients & Methods
TDR evaluation of 2781 newly diagnosed HIV-1 patients from CoRIS (2007-2011) : WHO list update in 2009. Stanford Resistance: Abacavir, Emtricitabine,
Lamivudine and Tenofovir; Efavirenz and Nevirapine; Atazanavir, Darunavir and Lopinavir.
Stanford categorization Any resistance (I+R); GSS(0=R, 0.5=I, 1=S) Linear trend over the study period
Global prevalence of Transmitted Drug Resistance (TDR) for the period 2007-2011 in Spain lies far below 10%.
Evaluation of TDR using the WHO surveillance list results in lower NNRTI resistance but higher PI & NRTI resistance.
While results by WHO list are very relevant to evaluate the transmission of resistant strains, interpretation of resistance is more informative for recommendations and clinical practice.
Baseline resistance to NNRTI containing regimens remains a problem of concern in Spain, through the period 2007-2011.
Resistance to first line PI containing regimens is less frequent, and very rare if a GSS <2.5 is considered.
Testing naïve patients initiating first line boosted-PIs may be not cost-effective in our setting.
Summary & Conclusions
Gracias¡¡¡¡
Susana Monge & Julia del Amo
RETIC RD06/006
All the Members of CoRIS-Resistance study: CoRIS Executive Committee: Juan Berenguer, Julia del Amo, Federico García, Félix Gutiérrez, Pablo Labarga, Santiago Moreno y María Ángeles Muñoz. Field work, data management and analysis: Paz Sobrino Vegas, Victoria Hernando Sebastián, Belén Alejos Ferreras, Débora Álvarez, Susana Monge, Inma Jarrín, Santiago Pérez Cachafeiro. BioBank: M Ángeles Muñoz-Fernández, Isabel García-Merino, Coral Gómez Rico, Jorge Gallego de la Fuente y Almudena García Torre & Participating Centres: