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Prevalence of K65R in patients treated with tenofovir disoproxil fumarate: recommendations based on the Frankfurt HIV Cohort Study Resistance Database (FHCS-RD)

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Abstract

Mutations in the genome of HIV-1 can compromise the success of antiretroviral treatments (ARTs) in HIV-1-infected individuals. The Frankfurt HIV Cohort Study Resistance Database (FHCS-RD) has previously documented a decline in the burden of resistance-associated mutations (RAMs) following the implementation of several new antiretroviral therapy regimens in 2007. In the current study, the annual burden of RAMs documented in the FHCS-RD in 2005–2013 was set in relation to the annual number of all cohort patients, drug regimens, available resistance tests, and prevalence for each RAM on relevant codons of reverse transcriptase (RT) and protease (PR) genes. A specific focus was put on the prevalence of the tenofovir disoproxil fumarate (TDF) signature mutation K65R in HIV-1 RT in relation to the application of TDF within ART. Between 2005 and 2012, a total of 4423 HIV genotyping data sets from 4509 patients were analysed. All mutations show a consistent decline, and the most impressive decrease was observed for thymidine analogue mutations (TAMs). The frequency of non-TAMs and PR mutations also decreased, but generally to a lower extent. The prevalence of K65R decreased from 2.6 % in 2005 to 0.2 % in 2012 despite increased use of TDF-containing ART. Both the improved strategic use of TDF in ARTs and generally more effective ART regimens may have resulted in decreasing RAM prevalences in FHCS-RD since 2007. These trends challenge the cost-effectiveness of resistance testing prior to failing ART.

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    Authors and Affiliations

    1. Institute for Medical Virology, University Hospital Frankfurt, Frankfurt am Main, Germany

      Claudia Reinheimer, Anna Wesner, Oliver T. Keppler, Hans Wilhelm Doerr & Martin Stürmer

    2. Institute for Medical Microbiology and Infection Control, University Hospital Frankfurt, Paul Ehrlich-Str. 40, 60596, Frankfurt am Main, Germany

      Claudia Reinheimer

    3. Max von Pettenkofer-Institute for Hygiene and Clinical Microbiology, Virology, Ludwig Maximilians-University, Munich, Germany

      Oliver T. Keppler

    4. Institute of Biostatistics and Mathematical Modeling, University Hospital Frankfurt, Frankfurt am Main, Germany

      Eva Herrmann

    5. Department for Internal Medicine II/Infectious Diseases, University Hospital Frankfurt, Frankfurt am Main, Germany

      Christoph Stephan

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    1. Claudia Reinheimer
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    Correspondence to Claudia Reinheimer.

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    All procedures performed in study were in accordance with the ethical standards of the Ethics Committee of Faculty of Medicine, Goethe University No 270/09.

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    Martin Stürmer and Christoph Stephan have equally contributed to this work.

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    Reinheimer, C., Wesner, A., Keppler, O.T. et al. Prevalence of K65R in patients treated with tenofovir disoproxil fumarate: recommendations based on the Frankfurt HIV Cohort Study Resistance Database (FHCS-RD). Med Microbiol Immunol 205, 315–320 (2016). https://doi.org/10.1007/s00430-015-0448-4

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    • DOI: https://doi.org/10.1007/s00430-015-0448-4

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