title: Transmitted antiretroviral drug resistance in New York State, 2006-2008: results from a new surveillance system.
abstract: BACKGROUND
  HIV transmitted drug resistance (TDR) is a public health concern because it has the potential to compromise antiretroviral therapy (ART) at the population level. In New York State, high prevalence of TDR in a local cohort and a multiclass resistant case cluster led to the development and implementation of a statewide resistance surveillance system.
  
  
  METHODS
  We conducted a cross-sectional analysis of the 13,109 cases of HIV infection that were newly diagnosed and reported in New York State between 2006 and 2008, including 4,155 with HIV genotypes drawn within 3 months of initial diagnosis and electronically reported to the new resistance surveillance system. We assessed compliance with DHHS recommendations for genotypic resistance testing and estimated TDR among new HIV diagnoses.
  
  
  RESULTS
  Of 13,109 new HIV diagnoses, 9,785 (75%) had laboratory evidence of utilization of HIV-related medical care, and 4,155 (43%) had a genotype performed within 3 months of initial diagnosis. Of these, 11.2% (95% confidence interval [CI], 10.2%-12.1%) had any evidence of TDR. The proportion with mutations associated with any antiretroviral agent in the NNRTI, NRTI or PI class was 6.3% (5.5%-7.0%), 4.3% (3.6%-4.9%) and 2.9% (2.4%-3.4%), respectively. Multiclass resistance was observed in <1%. TDR did not increase significantly over time (p for trend = 0.204). Men who have sex with men were not more likely to have TDR than persons with heterosexual risk factor (OR 1.0 (0.77-1.30)). TDR to EFV+TDF+FTC and LPV/r+TDF+FTC regimens was 7.1% (6.3%-7.9%) and 1.4% (1.0%-1.8%), respectively.
  
  
  CONCLUSIONS
  TDR appears to be evenly distributed and stable among new HIV diagnoses in New York State; multiclass TDR is rare. Less than half of new diagnoses initiating care received a genotype per DHHS guidelines.
authors.affiliation: The New York City Department of Health and Mental Hygiene, HIV Epidemiology and Field Services Program, New York, New York, United States of America.
authors.forename: Adam C
authors.initials: AC
authors.lastname: Readhead
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Gordon
authors.forename: Zhengyan
authors.initials: Z
authors.lastname: Wang
authors.forename: Bridget J
authors.initials: BJ
authors.lastname: Anderson
authors.forename: Kathleen S
authors.initials: KS
authors.lastname: Brousseau
authors.forename: Maria A
authors.initials: MA
authors.lastname: Kouznetsova
authors.forename: Lisa A
authors.initials: LA
authors.lastname: Forgione
authors.forename: Lou C
authors.initials: LC
authors.lastname: Smith
authors.forename: Lucia V
authors.initials: LV
authors.lastname: Torian
mesh_terms: D000293:Adolescent; D000328:Adult; D044966:Anti-Retroviral Agents / Q000494:pharmacology / Q000627:therapeutic use; D002648:Child; D003710:Demography; D024882:Drug Resistance, Viral / Q000187:drug effects / Q000235:genetics; D005260:Female; D005838:Genotype; D015658:HIV Infections / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000635:transmission*; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics; D009518:New York / Q000453:epidemiology; D011159:Population Surveillance; D055815:Young Adult
chemical_list: D044966:Anti-Retroviral Agents