title: Late presentation and transmitted drug resistance mutations in new HIV-1 diagnoses in Detroit.
abstract: OBJECTIVE
  To characterize the epidemiology and transmitted drug resistance mutation (TDRM) patterns among individuals with newly diagnosed HIV-1 infection seen at Henry Ford Hospital in Detroit from 2006 to 2008.
  
  
  METHODS
  This was a retrospective analysis of medical records from individuals aged ≥ 18 years with a new diagnosis of HIV-1 infection. Individuals who underwent genotypic resistance testing were included in the study.
  
  
  RESULTS
  One hundred thirty-three individuals were included; 99 (74%) were males, 104 (78%) were African-Americans, and 61 (46%) had a CD4+ count of ≤ 200 cells/μl. The prevalence of TDRM was 17% (23/133). Non-nucleoside reverse transcriptase mutations occurred in 11 (8%), nucleoside reverse transcriptase mutations in 13 (10%), and protease inhibitor mutations in 10 (8%). CD4+ count >350 cells/μl and HIV viral load on presentation were associated with TDRM in the multivariate analysis (p=0.004 and p<0.001 respectively).
  
  
  CONCLUSIONS
  Late diagnosis of HIV-1 and transmitted antiretroviral resistance are relatively common in Detroit. While most newly diagnosed persons were candidates for antiretroviral therapy on presentation, the high prevalence of TDRM has significant implications in the selection of first-line highly active antiretroviral therapy (HAART).
authors.affiliation: Department of Internal Medicine, Henry Ford Hospital, 2799W. Grand Blvd, Detroit, MI 48202, USA. mhuamanjoo@gmail.com
authors.forename: Moises A
authors.initials: MA
authors.lastname: Huaman
authors.forename: Javier
authors.initials: J
authors.lastname: Aguilar
authors.forename: Dwayne
authors.initials: D
authors.lastname: Baxa
authors.forename: Alicia
authors.initials: A
authors.lastname: Golembieski
authors.forename: Indira
authors.initials: I
authors.lastname: Brar
authors.forename: Norman
authors.initials: N
authors.lastname: Markowitz
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy / Q000453:epidemiology / Q000635:transmission / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D008297:Male; D008824:Michigan / Q000453:epidemiology; D008875:Middle Aged; D015999:Multivariate Analysis; D009154:Mutation / Q000235:genetics*; D015995:Prevalence; D012189:Retrospective Studies; D019562:Viral Load; D055815:Young Adult