title: Transmitted antiretroviral drug resistance in individuals with newly diagnosed HIV infection: South Carolina 2005-2009.
abstract: OBJECTIVE
  The transmission of drug-resistant human immunodeficiency virus 1 (HIV-1) has important implications for the antiretroviral management of newly diagnosed individuals, increasing the risk of suboptimal treatment outcomes. The study objective was to characterize rates and factors associated with transmitted drug-resistant HIV-1 infection among newly diagnosed South Carolina (SC) residents.
  
  
  METHODS
  This study utilized surveillance genotypic data from antiretroviral therapy (ART)-naïve individuals newly diagnosed with HIV-1 infection from June 2005 through December 2009. Multivariable negative binomial regression was used to model the association between the presence of major mutations and sociodemographic characteristics.
  
  
  RESULTS
  Of the 1,277 study participants, 14.4% (184/1,277) had HIV-1 variants with major antiretroviral drug mutations. Of these individuals, 126 had non-nucleoside reverse transcriptase inhibitor-associated mutations (NNRTI), 54 had nucleos(t)ide reverse transcriptase inhibitor-associated mutations (NRTI), 37 had protease inhibitor-associated mutations (PI). Nineteen (10.3%) individuals had dual class-associated mutations (NNRTI and PI in seven, NNRTI and NRTI in seven, and NRTI and PI in five individuals), and seven (3.8%) individuals had triple drug class-associated mutations (PI, NNRTI, and NRTI). The multivariable negative binomial regression models indicated that age at HIV diagnosis had a significant negative association with total number of mutations (rate ratio [RR] 0.88, 95% confidence interval [CI] 0.80-0.96, P value=0.005) and total number of reverse transcriptase (RT) mutations (RR 0.88, 95% CI 0.80-0.97, P value=0.006) present.
  
  
  CONCLUSIONS
  Prevalence of transmitted drug resistance is consistently high among newly diagnosed HIV-infected individuals in SC. It is important to continue genotypic surveillance to facilitate effective HIV treatment and empiric post-exposure prophylaxis regimens.
authors.affiliation: Arnold School of Public Health, Department of Epidemiology and Biostatistics, University of South Carolina, Columbia, SC 29208, USA.
authors.forename: Eren
authors.initials: E
authors.lastname: Youmans
authors.forename: Avnish
authors.initials: A
authors.lastname: Tripathi
authors.forename: Helmut
authors.initials: H
authors.lastname: Albrecht
authors.forename: James J
authors.initials: JJ
authors.lastname: Gibson
authors.forename: Wayne A
authors.initials: WA
authors.lastname: Duffus
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D018791:CD4 Lymphocyte Count; D024921:Drug Resistance, Multiple, Viral / Q000235:genetics; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015995:Prevalence; D013022:South Carolina / Q000453:epidemiology; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents