HIV-1 drug-resistance transmission compromises the effectiveness of antiretroviral therapy. Thus, epidemiological studies of resistance in naïve patients acquire a major relevance for the first treatment design. However, their methodological heterogeneity complicates the comparison of results. The global transmitted primary resistance prevalence in Spain from 1997 through 2008 was 10.6%, similar to the rest of Europe. Regarding drug families, prevalence was 5.8% for NRTI, 5% for NNRTI and 3.8% for PI. In further studies, it should be considered: i) to homogenize resistance testing favouring genetic sequencing instead of other methods and to improve minority resistances detection; ii) to create a unique mutations list to be applied to all HIV-1 variants; iii) to be aware of the circulating subtypes and established therapy in the areas of infection that could determine the resistance pattern; and iv) to promote multicenter studies including representative and numerous populations.
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