title: Transmitted antiretroviral drug resistance among newly HIV-1 diagnosed young individuals in Kampala.
abstract: OBJECTIVE
  To assess the emergence of transmitted HIV-1 drug resistance (TDR) in Kampala, Uganda, 10 years after the scale-up of antiretroviral treatment (ART) and to compare with a previous survey among antenatal clinic attendees in 2007 (reporting 0% TDR).
  
  
  METHODS
  A cross-sectional survey was conducted among newly HIV-1 diagnosed, antiretroviral-naive young adults attending two large voluntary counseling and testing centers within the geographic area of Kampala.
  
  
  METHODS
  Proxy criteria for recent HIV-1 infection were used as defined by the WHO. Population sequencing of the pol gene was performed on plasma samples with HIV-1 RNA at least 1000 copies/ml. Surveillance drug resistance mutations (SDRMs) were identified according to the 2009 WHO list for surveillance of TDR. HIV-1 subtypes were designated using maximum likelihood phylogenetic reconstruction.
  
  
  RESULTS
  : Genotypic test results were obtained for 70 of 77 (90.9%) participants. SDRMs were identified in six samples yielding a prevalence of TDR of 8.6% (95% confidence interval 3.2-17.7%). Two had SDRMs to nucleoside reverse-transcriptase inhibitors (D67G and L210W), three had SDRMs to nonnucleoside reverse transcriptase inhibitors (G190A, G190S, and K101E), and one had SDRMs to protease inhibitors (N88D). Frequencies of HIV-1 subtypes were A (36/70, 51.4%), C ( two of 70; 2.9%), D (23/70, 32.9%), and unique recombinant forms (nine of 70, 12.9%).
  
  
  CONCLUSIONS
  This repeated survey suggests an increase in TDR in Kampala, compared with a previous survey. This finding justifies increased vigilance with respect to surveillance of TDR in areas in Africa where ART programs are rolled-out.
authors.affiliation: MRC/UVRI, Uganda Research Unit on AIDS, Entebbe, Uganda. ndembinic@yahoo.fr
authors.forename: Nicaise
authors.initials: N
authors.lastname: Ndembi
authors.forename: Raph L
authors.initials: RL
authors.lastname: Hamers
authors.forename: Kim C E
authors.initials: KC
authors.lastname: Sigaloff
authors.forename: Frederick
authors.initials: F
authors.lastname: Lyagoba
authors.forename: Brian
authors.initials: B
authors.lastname: Magambo
authors.forename: Bridget
authors.initials: B
authors.lastname: Nanteza
authors.forename: Christine
authors.initials: C
authors.lastname: Watera
authors.forename: Pontiano
authors.initials: P
authors.lastname: Kaleebu
authors.forename: Tobias F
authors.initials: TF
authors.lastname: Rinke de Wit
mesh_terms: D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015751:Genes, pol / Q000187:drug effects; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000235:genetics / Q000635:transmission; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D008297:Male; D011247:Pregnancy; D015995:Prevalence; D014454:Uganda; D055815:Young Adult