Patterns of transmitted HIV drug resistance in Europe vary by risk group

PLoS One. 2014 Apr 10;9(4):e94495. doi: 10.1371/journal.pone.0094495. eCollection 2014.


Background: In Europe, a continuous programme (SPREAD) has been in place for ten years to study transmission of drug resistant HIV. We analysed time trends of transmitted drug resistance mutations (TDRM) in relation to the risk behaviour reported.

Methods: HIV-1 patients newly diagnosed in 27 countries from 2002 through 2007 were included. Inclusion was representative for risk group and geographical distribution in the participating countries in Europe. Trends over time were calculated by logistic regression.

Results: From the 4317 patients included, the majority was men-having-sex-with-men -MSM (2084, 48%), followed by heterosexuals (1501, 35%) and injection drug users (IDU) (355, 8%). MSM were more often from Western Europe origin, infected with subtype B virus, and recently infected (<1 year) (p<0.001). The prevalence of TDRM was highest in MSM (prevalence of 11.1%), followed by heterosexuals (6.6%) and IDU (5.1%, p<0.001). TDRM was predominantly ascribed to nucleoside reverse transcriptase inhibitors (NRTI) with a prevalence of 6.6% in MSM, 3.3% in heterosexuals and 2.0% in IDU (p = 0.001). A significant increase in resistance to non- nucleoside reverse transcriptase inhibitors (NNRTIs) and a decrease in resistance to protease inhibitors was observed in MSM (p = 0.008 and p = 0.006, respectively), but not in heterosexual patients (p = 0.68 and p = 0.14, respectively).

Conclusions: MSM showed to have significantly higher TDRM prevalence compared to heterosexuals and IDU. The increasing NNRTI resistance in MSM is likely to negatively influence the therapy response of first-line therapy, as most include NNRTI drugs.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Anti-HIV Agents / therapeutic use*
  • Drug Resistance, Viral*
  • Europe / epidemiology
  • Female
  • HIV Infections / drug therapy
  • HIV Infections / epidemiology
  • HIV Infections / transmission*
  • HIV Infections / virology
  • HIV-1 / drug effects*
  • Heterosexuality / statistics & numerical data
  • Homosexuality, Male / statistics & numerical data
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Protease Inhibitors / therapeutic use
  • Reverse Transcriptase Inhibitors / therapeutic use
  • Risk
  • Risk-Taking*
  • Sexual Behavior / statistics & numerical data
  • Substance Abuse, Intravenous / epidemiology
  • Substance Abuse, Intravenous / virology*


  • Anti-HIV Agents
  • Protease Inhibitors
  • Reverse Transcriptase Inhibitors

Grant support

This work was supported by the European Commission (grant QLK2-CT-2001-01344, fifth framework; grant LSHP-CT-2006-518211, sixth framework, grant DynaNets no. 233847, grant CHAIN no. 223131, seventh framework); Belgian AIDS Reference Laboratory Fund, Belgian Fonds voor Wetenschappelijk Onderzoek (grant G.0611.09); Interuniversitaire Attractiepolen (Belgium; grant P6/41); Cyprus Research Promotion Foundation (grant Health/0104/22); Danish AIDS Foundation; Ministry of Health (Germany; grant 1502-686-18); Ministry of Education and Research (Germany; grant 01KI501); Fifth National Program on HIV/AIDS, Istituto Superiore di Sanità (Italy; grants N 40F.56 and 20D.1.6); Fondation Recherche sur le SiDA; Ministry of Health (Luxembourg); Swedish Research Council; Swedish Civil Contingencies Agency; CHAIN, Collaborative HIV and Anti-HIV Drug Resistance Network, (Integrated Project no. 223131, funded by the European Commission Framework 7 Program); and Ministry of Education and Science (Republic of Serbia; grant 175024). ABA is supported by Fundação para a Ciência e Tecnologia (grant no. SFRH/BPD/65605/2009), and Slovak Ministry of Health-project (No. 2005/37-SZU-15). The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.