Prevalence of Transmitted HIV Drug Resistance among Recently Infected Persons in San Diego, CA 1996-2013
BACKGROUND:
Transmitted
drug resistance (TDR) remains an important concern when initiating
antiretroviral therapy (ART). Here, we describe the prevalence and phylogenetic
relationships of TDR among ART-naive, HIV-infected individuals in San Diego
from 1996 to 2013.
METHODS:
Data were
analyzed from 496 participants of the San Diego Primary Infection Cohort who
underwent genotypic resistance testing before initiating therapy. Mutations
associated with drug resistance were identified according to the WHO-2009
surveillance list. Network and phylogenetic analyses of the HIV-1 pol sequences
were used to evaluate the relationships of TDR within the context of the entire
cohort.
RESULTS:
The
overall prevalence of TDR was 13.5% (67/496), with an increasing trend over the
study period (P = 0.005). TDR was predominantly toward nonnucleoside reverse
transcriptase inhibitors (NNRTIs) [8.5% (42/496)], also increasing over the
study period (P = 0.005). By contrast, TDR to protease inhibitors and
nucleos(t)ide reverse transcriptase inhibitors were 4.4% (22/496) and 3.8%
(19/496), respectively, and did not vary with time. TDR prevalence did not
differ by age, gender, race/ethnicity, or risk factors. Using phylogenetic
analysis, we identified 52 transmission clusters, including 8 with at least 2
individuals sharing the same mutation, accounting for 23.8% (16/67) of the
individuals with TDR.
CONCLUSIONS:
Between
1996 and 2013, the prevalence of TDR significantly increased among recently
infected ART-naive individuals in San Diego. Around one-fourth of TDR occurred within
clusters of recently infected individuals. These findings highlight the
importance of baseline resistance testing to guide selection of ART and for
public health monitoring.
By: Panichsillapakit T1, Smith DM, Wertheim JO, Richman DD, Little SJ, Mehta SR.
- 1*Department of Preventive and Social Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand; †Department of Medicine, University of California, San Diego, CA; ‡Veterans Affairs San Diego Healthcare System, San Diego, CA; and §Department of Pathology, University of California, San Diego, CA.
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