title: Transmitted antiretroviral drug resistance among acute and recent HIV infections in North Carolina from 1998 to 2007.
abstract: BACKGROUND
  Transmitted drug resistance (TDR) limits antiretroviral options and thus complicates the management of HIV-positive patients. HIV disproportionately affects the southern US, but available national estimates of TDR prevalence principally reflect large metropolitan centres outside this region.
  
  
  METHODS
  The Duke/UNC Acute HIV Program has collected data on acute or recent HIV infections (ARHI) in North Carolina since 1998. Acute infections represent antibody-negative, RNA-positive patients. Recent infection was determined by history of HIV testing or concordance between detuned ELISA and antibody avidity assays. Genotypic sequence data from the earliest collected pretreatment plasma samples were analysed with the Stanford HIV Database and screened for surveillance drug resistance mutations (SDRMs).
  
  
  RESULTS
  A total of 253 individuals with ARHI between May 1998 and May 2007 had complete genotypic sequence data for analysis; 39.5% were acute infections, 78.7% were male, 64.8% were non-White and 53.8% were men who have sex with men. The overall prevalence of TDR was 17.8%, with SDRMs for non-nucleoside/nucleotide reverse transcriptase inhibitors (NNRTIs) in 9.5% of the cohort. Mutations for nucleoside/nucleotide reverse transcriptase inhibitors (NRTIs) were detected in 7.5% and for protease inhibitors (PIs) in 3.2%. K103N was the most common mutation (7.5%). Thymidine analogue mutations were found in 4.7% of samples; the most common PI SDRM was L90M (2.4%). Dual- or triple-class antiretroviral resistance was rare, encountered in only six (2.4%) samples.
  
  
  CONCLUSIONS
  The prevalence of TDR in North Carolina is similar to estimates from the US metropolitan areas. These findings have implications for initial regimen selection and secondary prevention efforts outside of large, metropolitan HIV epicentres.
authors.affiliation: Division of Infectious Diseases, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA. christopher_hurt@med.unc.edu
authors.forename: Christopher B
authors.initials: CB
authors.lastname: Hurt
authors.forename: Sandra I
authors.initials: SI
authors.lastname: McCoy
authors.forename: Joann
authors.initials: J
authors.lastname: Kuruc
authors.forename: Julie Ae
authors.initials: JA
authors.lastname: Nelson
authors.forename: Melissa
authors.initials: M
authors.lastname: Kerkau
authors.forename: Susan
authors.initials: S
authors.lastname: Fiscus
authors.forename: Kara
authors.initials: K
authors.lastname: McGee
authors.forename: Joseph
authors.initials: J
authors.lastname: Sebastian
authors.forename: Peter
authors.initials: P
authors.lastname: Leone
authors.forename: Christopher
authors.initials: C
authors.lastname: Pilcher
authors.forename: Charles
authors.initials: C
authors.lastname: Hicks
authors.forename: Joseph
authors.initials: J
authors.lastname: Eron
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000635:transmission* / Q000821:virology; D017320:HIV Protease Inhibitors / Q000494:pharmacology / Q000627:therapeutic use; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D009657:North Carolina / Q000453:epidemiology; D021141:Nucleic Acid Amplification Techniques; D011159:Population Surveillance / Q000379:methods; D015995:Prevalence; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents; D017320:HIV Protease Inhibitors; D018894:Reverse Transcriptase Inhibitors
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