Low prevalence of transmitted antiretroviral drug resistance in a large UK HIV-1 cohort.

OBJECTIVES: To describe current practice in testing for transmitted antiretroviral drug resistance (TDR) and the prevalence of TDR in a large UK HIV-1 cohort. METHODS: The study includes a retrospective analysis of newly diagnosed HIV-1-infected patients presenting to eight HIV clinics in the north of England between March 2005 and March 2007. Resistance mutations were defined by IAS-USA. Predicted phenotypes were calculated by the Stanford University database. RESULTS: Five hundred and fifty-eight patients were studied, of whom 394 (70.6%) had heterosexually acquired HIV and 377 (67.6%) were infected outside the UK. TDR testing was performed in 406 patients (72.8%). Thirteen of 392 viral resistance profiles (3.3%) showed genotypic TDR. There was no significant association between TDR and any demographic or risk factor or baseline CD4 count. In particular, rates of TDR were similar in white British (6/147, 4.1%) and black African (7/224, 3.1%) patients. The numbers of patients with TDR to individual drug classes were: nucleoside reverse transcriptase inhibitors, 2 (0.5%); non-nucleoside reverse transcriptase inhibitors, 7 (1.8%); and protease inhibitors, 4 (1.0%). No patients had multi-class resistance detected. Eleven patients (2.8%) were predicted to have significant phenotypic resistance to at least one drug. CONCLUSIONS: In a large unselected UK cohort, with high coverage of TDR testing, the prevalence of TDR was low and is in accordance with recent data, showing a decrease in the prevalence of TDR in the UK. Differences in population mix did not appear to explain this low rate.

Evaluation, using two assessment instruments, of the American and British national guidelines for the management of sexually transmissible and genital infections.

BACKGROUND: The objective of the present study was to compare, utilising two guideline assessment instruments, six corresponding clinical practice guidelines of the British Association for Sexual Health and HIV and the Centres for Disease Control. METHODS: Three raters independently assessed the recently published guidelines for gonorrhoea, chlamydial infection, early syphilis, pelvic inflammatory disease, bacterial vaginosis and HIV testing using two instruments, the Cluzeau and the AGREE (Appraisal of Guidelines for Research and Evaluation instrument). The Cluzeau scores were a simple percentage comparison; the AGREE scores were a standardised score for each guideline development domain. Differences were assessed using the Wilcoxson signed ranks test. Inter-rater variability was calculated on the Cluzeau instrument utilising the intragroup correlation method. RESULTS: The British Association for Sexual Health and HIV guidelines scored higher than the Centres for Disease Control guidelines in many of the assessed domains. There were significant differences between the two in many of the scores (P = 0.026-0.028). Inter-rater concordance was high to very high at 0.70-0.83. CONCLUSIONS: There were often major differences in scores between the two guideline groups. It is necessary for wider discussion within the profession to consider the significance of these findings.