Background Transmitted drug resistance (TDR) remains an important concern when initiating antiretroviral therapy (ART). Here we describe the prevalence and phylogenetic relationships of TDR among ART-naïve, HIV-infected individuals in San Diego from 1996-2013. Methods Data were analyzed from 496 participants of the San Diego Primary Infection Cohort who underwent genotypic resistance testing before initiating therapy. Mutations associated with drug resistance were identified according to the WHO-2009 surveillance list. Network and phylogenetic analyses of the HIV-1 pol sequences were used to evaluate the relationships of TDR within the context of the entire cohort. Results The overall prevalence of TDR was 13.5% (67/496), with an increasing trend over the study period (p=0.005). TDR was predominantly toward non-nucleoside reverse transcriptase inhibitors (NNRTIs) [8.5% (42/496)], also increasing over the study period (p=0.005). In contrast, TDR to protease inhibitors and nucleos(t)ide reverse transcriptase inhibitors were 4.4% (22/496) and 3.8% (19/496) respectively, and did not vary with time. TDR prevalence did not differ by age, gender, race/ethnicity or risk factor. Using phylogenetic analysis, we identified 52 transmission clusters, including eight with at least two individuals sharing the same mutation, accounting for 23.8% (16/67) of the individuals with TDR. Conclusions Between 1996 and 2013, the prevalence of TDR significantly increased among recently infected ART-naïve individuals in San Diego. Around one-fourth of TDR occurred within clusters of recently infected individuals. These findings highlight the importance of baseline resistance testing to guide selection of ART and for public health monitoring.

SummaryMany studies have found an association between abnormal body mass index (BMI) and poor outcomes among lung transplant recipients. We performed a systematic review and meta-analysis to identify outcomes associated with an abnormal pretransplant BMI after lung transplantation (LTx). The MEDLINE and EMBASE databases were searched from inception to May 2015 with focus on original observational studies with post-transplant survival data in candidates with abnormal BMI (underweight, overweight, or obese). We performed metaanalyses examining survival and primary graft dysfunction after LTx. We identified 866 citations; 13 observational cohort studies involving 40 742 participants met our inclusion criteria for systematic review. Seven of the 13 were included in the meta-analysis. There was a significant risk of mortality after LTx in candidates with underweight and obesity (underweight versus normal, relative risk [RR] 1.36, 95% confidence interval [CI] 1.11-1.66, I 2 = 0%; obesity vs. normal, RR 1.90, 95% CI 1.45-2.56, I 2 = 0%; overweight vs. normal, RR 1.36, 95% CI 1.11-1.66, I 2 = 0). There was also a significant risk of primary graft dysfunction in obese (RR 1.92, 95% CI 1.39-2.65, I 2 = 0%) and overweight (RR 1.72, 95% CI, 1.32-2.24, I 2 = 0%) candidates. Lung transplant candidates who are underweight or obese have a higher risk of post-transplant mortality than recipients with a normal BMI.

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