title: Prevalence of drug-resistant and nonsubtype B HIV strains in antiretroviral-naïve, HIV-infected individuals in New York State.
abstract: The duration of HIV infection is usually unknown for most patients entering into HIV care. Data on the frequency at which resistance mutations are detected in these patients are needed to support practical guidance on the use of resistance testing in this clinical situation. Furthermore, little is known about HIV subtype diversity in much of the United States. Therefore, we analyzed the prevalence of drug resistance mutations and nonsubtype B strains of HIV among antiretroviral-naïve individuals presenting for HIV care in New York State between September 2000 and January 2004. Sequences were obtained using a commercial HIV genotyping assay. Seventeen of 151 subjects (11.3%; 95% confidence interval 7.2%-17.3%) had at least one drug-resistance mutation, including 5 subjects with fewer than 200 CD4(+) T cells, indicative of advanced infection. Nucleoside reverse transcriptase inhibitor, non-nucleoside reverse transcriptase inhibitor, and protease inhibitor resistance mutations were detected in 6.6%, 5.3%, and 0.7% of subjects, respectively. Subjects from New York City-based clinics were less likely to have resistant virus than subjects from clinics elsewhere in New York State. Nonsubtype B strains of HIV were detected in 9 (6.0%) individuals and were associated with heterosexual contact. Two nonsubtype B strains from this cohort also carried drug-resistance mutations. These data indicate that drug-resistant virus is frequently detected in antiretroviral-naïve individuals entering HIV care in New York State. Furthermore, a diverse set of nonsubtype B strains were identified and evidence suggests that nonsubtype B strains, including those carrying drug-resistance mutations, are being transmitted in New York State.
authors.affiliation: Wadsworth Center, New York State Department of Health, Albany, New York, USA. mmp09@health.state.ny.us
authors.forename: Monica M
authors.initials: MM
authors.lastname: Parker
authors.forename: Daniel
authors.initials: D
authors.lastname: Gordon
authors.forename: Andrew
authors.initials: A
authors.lastname: Reilly
authors.forename: Harold W
authors.initials: HW
authors.lastname: Horowitz
authors.forename: Mark
authors.initials: M
authors.lastname: Waters
authors.forename: Ryan
authors.initials: R
authors.lastname: Bennett
authors.forename: Renee
authors.initials: R
authors.lastname: Hallack
authors.forename: Joseph
authors.initials: J
authors.lastname: Smith
authors.forename: Daryl
authors.initials: D
authors.lastname: Lamson
authors.forename: Aida
authors.initials: A
authors.lastname: Aydemir
authors.forename: Natia
authors.initials: N
authors.lastname: Dvali
authors.forename: Bruce D
authors.initials: BD
authors.lastname: Agins
authors.forename: George L
authors.initials: GL
authors.lastname: Drusano
authors.forename: Jill
authors.initials: J
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D006678:HIV / Q000145:classification / Q000235:genetics*; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000235:genetics*; D017320:HIV Protease Inhibitors / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D009518:New York / Q000453:epidemiology; D015995:Prevalence; D012367:RNA, Viral / Q000097:blood / Q000235:genetics*; D018894:Reverse Transcriptase Inhibitors / Q000627:therapeutic use
chemical_list: D017320:HIV Protease Inhibitors; D012367:RNA, Viral; D018894:Reverse Transcriptase Inhibitors