Routine surveillance for the detection of acute and recent HIV infections and transmission of antiretroviral resistance.
OBJECTIVE
To estimate the rate of acute and recent HIV infections and the prevalence of primary antiretroviral resistance.


METHODS
A consecutive sample of individuals presenting for HIV testing at the San Francisco municipal sexually transmitted diseased (STD) clinic in 2004 (n = 3789).


METHODS
HIV antibody-positive specimens were screened by BED IgG capture enzyme immunoassay to identify recent infections. HIV antibody-negative specimens were screened by nucleic acid amplification testing (NAAT) to detect acute infections. Newly detected infections were genotyped to detect primary antiretroviral resistance.


RESULTS
There were 11 acute and 44 recent HIV infections among the total 136 newly detected cases. NAAT increased case identification by 8.08% over standard antibody testing. Acute HIV infections were associated with having a known HIV-positive partner, and a history of hepatitis B, syphilis, and chlamydia. The prevalence of primary antiretroviral resistance was 13.2%, with drug-resistant mutations detected in 17 of 129 cases genotyped. Mutations conferring resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) were present in 11 of 17 cases.


CONCLUSIONS
The integration of HIV nucleic acid amplification, recent infection, and antiretroviral resistance testing enhanced HIV/STD surveillance. The high proportion of NNRTI mutations detected suggests they may be more common in source partners or more fit for transmission than other forms of drug-resistant HIV-1. Primary antiretroviral resistance monitoring in STD clinic patients may guide the selection of treatment and post-exposure prophylaxis regimens active against viruses being transmitted in the community, and provide health departments with surveillance data in a sentinel population at risk of HIV transmission.
Truong
Hong-Ha M
HM
University of California-San Francisco, 50 Beale Street, San Francisco, CA 94105, USA. Hong-Ha.Truong@ucsf.edu
Grant
Robert M
RM
McFarland
Willi
W
Kellogg
Timothy
T
Kent
Charlotte
C
Louie
Brian
B
Wong
Ernest
E
Klausner
Jeffrey D
JD
D000208:Acute Disease; D000328:Adult; D000368:Aged; D000465:Algorithms; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000453:epidemiology; D018451:Homosexuality, Male / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use*; D012495:San Francisco / Q000453:epidemiology
D018894:Reverse Transcriptase Inhibitors