Increase of transmitted drug resistance among HIV-infected sub-Saharan Africans residing in Spain in contrast to the native population

Gonzalo Yebra, Miguel de Mulder, María Jesús Pérez-Elías, José Antonio Pérez-Molina, Juan Carlos Galán, Jara Llenas-García, Santiago Moreno, África Holguín

Research output: Contribution to journalArticlepeer-review


BACKGROUND: The prevalence of transmitted HIV drug resistance (TDR) is stabilizing or decreasing in developed countries. However, this trend is not specifically evaluated among immigrants from regions without well-implemented antiretroviral strategies.

METHODS: TDR trends during 1996-2010 were analyzed among naïve HIV-infected patients in Spain, considering their origin and other factors. TDR mutations were defined according to the World Health Organization list.

RESULTS: Pol sequence was available for 732 HIV-infected patients: 292 native Spanish, 226 sub-Saharan Africans (SSA), 114 Central-South Americans (CSA) and 100 from other regions. Global TDR prevalence was 9.7% (10.6% for Spanish, 8.4% for SSA and 7.9% for CSA). The highest prevalences were found for protease inhibitors (PI) in Spanish (3.1%), for non-nucleoside reverse transcriptase inhibitors (NNRTI) in SSA (6.5%) and for nucleoside reverse transcriptase inhibitors (NRTI) in both Spanish and SSA (6.5%). The global TDR rate decreased from 11.3% in 2004-2006 to 8.4% in 2007-2010. Characteristics related to a decreasing TDR trend in 2007-10 were Spanish and CSA origin, NRTI- and NNRTI-resistance, HIV-1 subtype B, male sex and infection through injection drug use. TDR remained stable for PI-resistance, in patients infected through sexual intercourse and in those carrying non-B variants. However, TDR increased among SSA and females. K103N was the predominant mutation in all groups and periods.

CONCLUSION: TDR prevalence tended to decrease among HIV-infected native Spanish and Central-South Americans, but it increased up to 13% in sub-Saharan immigrants in 2007-2010. These results highlight the importance of a specific TDR surveillance among immigrants to prevent future therapeutic failures, especially when administering NNRTIs.

Original languageEnglish
Article numbere26757
Number of pages8
JournalPLoS ONE
Issue number10
Publication statusPublished - 2011


  • Africa South of the Sahara
  • Antiviral Agents
  • Drug Resistance, Viral
  • Emigrants and Immigrants
  • HIV Infections
  • Humans
  • Mutation
  • Prevalence
  • Spain
  • Journal Article
  • Research Support, Non-U.S. Gov't


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