Global HIV-1 transmitted drug resistance in the INSIGHT Strategic Timing of Anti Retroviral Treatment ( START) trial.

Objectives HIV-1 transmitted drug resistance ( TDR) in treatment-naïve individuals is a well-described phenomenon. Baseline genotypic resistance testing is considered standard of care in most developed areas of the world. The aim of this analysis was to characterize HIV-1 TDR and the use of resistance testing in START trial participants. Methods In the Strategic Timing of Anti Retroviral Treatment ( START) trial, baseline genotypic resistance testing results were collected at study entry and analysed centrally to determine the prevalence of TDR in the study population. Resistance was based on a modified 2009 World Health Organization definition to reflect newer resistance mutations. Results Baseline resistance testing was available in 1946 study participants. Higher rates of testing occurred in Europe (86.7%), the USA (81.3%) and Australia (89.9%) as compared with Asia (22.2%), South America (1.8%) and Africa (0.1%). The overall prevalence of TDR was 10.1%, more commonly to nonnucleoside reverse transcriptase inhibitors (4.5%) and nucleoside reverse transcriptase inhibitors (4%) compared with protease inhibitors (2.8%). The most frequent TDR mutations observed were M41L, D67 N/ G/ E, T215 F/ Y/ I/ S/ C/ D/ E/ V/ N, 219 Q/ E/ N/ R, K103 N/ S, and G190 A/ S/ E in reverse transcriptase, and M46 I/L and L90 M in protease. By country, the prevalence of TDR was highest in Australia (17.5%), France (16.7%), the USA (12.6%) and Spain (12.6%). No participant characteristics were identified as predictors of the presence of TDR. Conclusions START participants enrolled in resource-rich areas of the world were more likely to have baseline resistance testing. In Europe, the USA and Australia, TDR prevalence rates varied by country. [ABSTRACT FROM AUTHOR]