Prevalence of antiretroviral drug resistance and resistance-associated mutations in antiretroviral therapy-naïve HIV-infected individuals from 40 United States cities.
BACKGROUND
Transmission of drug-resistant HIV strains to antiretroviral therapy (ART)-naïve subjects can negatively impact therapy response. As treatment strategies and utilization of antiretroviral drugs evolve, patterns of transmitted mutations may shift.


METHODS
Paired genotypic and phenotypic susceptibility data were retrospectively analyzed for 317 ART-naïve, HIV-infected subjects from 40 small and major metropolitan cities in the Northeastern, Midwestern, Southern, Southwestern, and Northwestern United States during 2003.


RESULTS
Using current (January 2007) PhenoSense cutoffs, HIV-from 8% of subjects had reduced susceptibility to > or = 1 drug. By class, < 1% had reduced susceptibility to protease inhibitors (PIs), and 1% had reduced susceptibility to nucleoside reverse transcriptase inhibitors (NRTIs); reduced susceptibility to > or = 1 non-nucleoside reverse transcriptase inhibitor (NNRTIs) was seen in 7% of subjects, with 4% of all subjects having reduced susceptibility to all NNRTIs. IAS-USA-defined NRTI, NNRTI, and/or major PI HIV-drug resistance-associated mutations were detected for 0% of the subjects. HIV risk factors included homosexual contact (74%), heterosexual contact (28%), and injectable drug use/transfusion/other (7%). Reduced susceptibility to > or = 1 drug was significantly higher (p = .034) for white subjects than African Americans and Hispanics/others.


CONCLUSIONS
The high prevalence of drug resistance in these ART-naïve subjects suggests that transmitted resistance is occurring widely within the United States. HIV genotyping and/or phenotyping for antiretroviral-naïve patients seeking treatment should be considered, especially if the therapy will include an NNRTI.
Ross
Lisa
L
GlaxoSmithKline, Research Triangle Park, NC 27709, USA. lisa.l.ross@gsk.com
Lim
Michael L
ML
Liao
Qiming
Q
Wine
Brian
B
Rodriguez
Allan E
AE
Weinberg
Winkler
W
Shaefer
Mark
M
D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology*; D015331:Cohort Studies; D018562:Disease Transmission, Infectious; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000453:epidemiology* / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D009154:Mutation; D011480:Protease Inhibitors / Q000494:pharmacology; D012189:Retrospective Studies; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology; D012307:Risk Factors; D012725:Sexual Behavior; D013045:Species Specificity; D015819:Substance Abuse, Intravenous; D014481:United States / Q000453:epidemiology; D014505:Urban Population; D044465:White People
D044966:Anti-Retroviral Agents; D011480:Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors