title: A multicenter study of initiation of antiretroviral therapy and transmitted drug resistance in antiretroviral-naive adolescents and young adults with HIV in New York City.
abstract: BACKGROUND
  In December 2009, the Department of Health and Human Services guidelines for initiation of antiretroviral therapy (ART) changed to include patients with CD4 counts between 350 and 500 cells/µL. The aims of this study were to assess uptake of this recommendation in ART-naive youth with human immunodeficiency virus (HIV) and to describe the epidemiology of transmitted genotypic drug resistance mutations (DRMs) in this population.
  
  
  METHODS
  A multicenter, retrospective cohort study of ART initiation in ART-naive youth was performed. Eligible subjects were 13-25 years of age, were diagnosed with HIV within 1 year of presentation to care at the study sites, and presented to care from January 2007 to June 2011.
  
  
  RESULTS
  Of 685 potential subjects identified, 331 (49%) fulfilled inclusion criteria. Mean CD4 count at presentation to care was 452 cells/µL. Overall, 191 (58%) subjects started ART. The mean CD4 count at ART initiation was 261 cells/µL before and 363 cells/µL after the 2009 guideline change (P < .0001). Of 212 (64%) subjects with resistance testing available prior to ART initiation, 38 (18%) subjects had a major DRM and an increased proportion of resistance was seen in later study years.
  
  
  CONCLUSIONS
  Our study demonstrated an uptake in recently changed guideline recommendations to treat HIV-infected individuals at higher CD4 counts and reinforces the importance of performing resistance testing at entry into care, as 18% of our population had major DRMs prior to initiation of ART.
authors.affiliation: Columbia University Medical Center, New York.
authors.forename: Christina
authors.initials: C
authors.lastname: Gagliardo
authors.forename: Ava
authors.initials: A
authors.lastname: Brozovich
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Birnbaum
authors.forename: Anita
authors.initials: A
authors.lastname: Radix
authors.forename: Marc
authors.initials: M
authors.lastname: Foca
authors.forename: John
authors.initials: J
authors.lastname: Nelson
authors.forename: Lisa
authors.initials: L
authors.lastname: Saiman
authors.forename: Michael
authors.initials: M
authors.lastname: Yin
authors.forename: Elektra
authors.initials: E
authors.lastname: Carras-Terzian
authors.forename: Emily
authors.initials: E
authors.lastname: West
authors.forename: Natalie
authors.initials: N
authors.lastname: Neu
mesh_terms: D000293:Adolescent; D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage*; D015331:Cohort Studies; D024882:Drug Resistance, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D009519:New York City / Q000453:epidemiology; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D019380:Anti-HIV Agents
keywords: HIV; adolescents; antiretroviral therapy; genotypic resistance; youth