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Increase in transmitted drug resistance in migrants from sub-Saharan Africa diagnosed with HIV-1 in Sweden

Journal article
Authors E. Andersson
A. Nordquist
J. Esbjörnsson
L. Flamholc
Magnus Gisslén
B. Hejdeman
G. Marrone
H. Norrgren
V. Svedhem
S. Wendahl
J. Albert
A. Sönnerborg
Published in AIDS
Volume 32
Issue 7
Pages 877-884
ISSN 0269-9370
Publication year 2018
Published at Institute of Biomedicine, Department of Infectious Medicine
Pages 877-884
Language en
Keywords antiretroviral drugs, drug resistance, HIV, sub-Saharan Africa, Sweden, transients and migrants, transmission, antiretrovirus agent, emtricitabine, lamivudine, nonnucleoside reverse transcriptase inhibitor, Pol protein, tenofovir, adult, Africa south of the Sahara, antiviral resistance, Article, CD4+ T lymphocyte, chi square test, cluster analysis, controlled study, female, gene mutation, gene sequence, heterosexuality, human, Human immunodeficiency virus 1 infection, Human immunodeficiency virus infected patient, logistic regression analysis, major clinical study, male, men who have sex with men, migrant, phylogeny, pre-exposure prophylaxis, prevalence, priority journal, trend study, virus transmission
Subject categories Infectious Medicine


Objective: To study the trends of transmitted drug resistance (TDR) in HIV-1 patients newly diagnosed in Sweden, 2010-2016. Design: Register-based study including all antiretroviral therapy-naive patients ≥18 years diagnosed with HIV-1 in Sweden 2010-2016. Methods: Patient data and viral pol sequences were extracted from the national InfCareHIV database. TDR was defined as the presence of surveillance drug resistance mutations (SDRMs). A CD4+ T-cell decline trajectory model estimated time of infection. Phylogenetic inference was used for cluster analysis. Chi-square tests and logistic regressions were used to investigate relations between TDR, epidemiological and viral factors. Results: One thousand, seven hundred and thirteen pol sequences were analyzed, corresponding to 71% of patients with a new HIV-1 diagnosis (heterosexuals: 53%; MSM: 34%). The overall prevalence of TDR was 7.1% (95% CI 5.8-8.3%). Nonnucleoside reverse transcriptase inhibitor (NNRTI) TDR increased significantly from 1.5% in 2010 to 6.2% in 2016, and was associated to infection and/or origin in sub-Saharan Africa (SSA). An MSM transmission cluster dating back to the 1990s with the M41L SDRM was identified. Twenty-five (1.5%) patients exhibited TDR to tenofovir (TDF; n = 8), emtricitabine/lamivudine (n = 9) or both (n = 8). Conclusion: NNRTI TDR has increased from 2010 to 2016 in HIV-1-infected migrants from SSA diagnosed in Sweden, mirroring the situation in SSA. TDR to tenofovir/emtricitabine, used in preexposure prophylaxis, confirms the clinical and epidemiological need for resistance testing in newly diagnosed patients.

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