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Original Article

Transmitted Antiretroviral Drug Resistance in Individuals with Newly Diagnosed HIV Infection: South Carolina 2005–2009

Eren Youmans, MPH, Avnish Tripathi, MD, MPH, Helmut Albrecht, MD, James J. Gibson, MD, MPH, Wayne A. Duffus, MD, PhD
Volume: 104 Issue: 2 February, 2011

Abstract:

Objectives: The transmission of drug-resistant human immunodeficiency virus 1 (HIV-1) has important implications for the antiretroviral management of newly diagnosed individuals, increasing the risk of suboptimal treatment outcomes. The study objective was to characterize rates and factors associated with transmitted drug-resistant HIV-1 infection among newly diagnosed South Carolina (SC) residents.


Methods: This study utilized surveillance genotypic data from antiretroviral therapy (ART)-naïve individuals newly diagnosed with HIV-1 infection from June 2005 through December 2009. Multivariable negative binomial regression was used to model the association between the presence of major mutations and sociodemographic characteristics.


Results: Of the 1,277 study participants, 14.4% (184/1,277) had HIV-1 variants with major antiretroviral drug mutations. Of these individuals, 126 had non-nucleoside reverse transcriptase inhibitor-associated mutations (NNRTI), 54 had nucleos(t)ide reverse transcriptase inhibitor-associated mutations (NRTI), 37 had protease inhibitor-associated mutations (PI). Nineteen (10.3%) individuals had dual class-associated mutations (NNRTI and PI in seven, NNRTI and NRTI in seven, and NRTI and PI in five individuals), and seven (3.8%) individuals had triple drug class-associated mutations (PI, NNRTI, and NRTI). The multivariable negative binomial regression models indicated that age at HIV diagnosis had a significant negative association with total number of mutations (rate ratio [RR] 0.88, 95% confidence interval [CI] 0.80–0.96, P value = 0.005) and total number of reverse transcriptase (RT) mutations (RR 0.88, 95% CI 0.80–0.97, P value = 0.006) present.


Conclusion: Prevalence of transmitted drug resistance is consistently high among newly diagnosed HIV-infected individuals in SC. It is important to continue genotypic surveillance to facilitate effective HIV treatment and empiric post-exposure prophylaxis regimens.


Key Points


* Unlike most of the studies in this content area, our study is based on statewide surveillance data of South Carolina and attempts to address the paucity of literature on transmitted drug resistance (TDR), especially in the southern United States.


* Results suggest high rates of TDR—including double and triple antiretroviral drug class resistance—among individuals with newly diagnosed human immunodeficiency virus (HIV) infection.


* We found that younger persons are more likely to have a higher number of major mutations at HIV diagnosis.


* The results reiterate the importance of continued genotypic surveillance to facilitate effective HIV treatment and empiric post-exposure prophylaxis regimens.

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