Transmitted Antiretroviral Drug Resistance in New York State, 2006-2008: Results from a New Surveillance System

Abstract

BackgroundHIV 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.MethodologyWe 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.Principal FindingsOf 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/SignificanceTDR 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.

Human immunodeficiency virus (HIV) in Washington, D.C.: Prevalence of antiretroviral resistance in treatment nave patients from 2007 to 2010

“…However, our overall TDR data mirror the mutation rates reported in other studies within the United States (Castor et al, 2012;Huaman et al, 2011;Hurt et al, 2009;Little et al, 1999;Little et al, 2002;MacVeigh et al, 2013;Readhead et al, 2012;Ross et al, 2007;Truong et al, 2011;Weinstock et al, 2000;Weinstock et al, 2004;Wheeler et al, 2010;Yanik et al, 2012;Youmans et al, 2011).…”

“…In addition, our rate of 15% NNRTI mutations contributing to NNRTI resistance was higher than what was typically reported for this drug class (Castor et al, 2012;Huaman et al, 2011;Hurt et al, 2009;Little et al, 2002;MacVeigh et al, 2013;Readhead et al, 2012;Ross et al, 2007;Taniguchi et al, 2012;Truong et al, 2011;Weinstock et al, 2000;Weinstock et al, 2004;Wheeler et al, 2010;Yanik et al, 2012;Youmans et al, 2011). The increase in TDR was primarily due to NNRTI mutations and occurred during the 4-year study period in a trend similar to other studies in the United States (Grant et al, 2002;Ross et al, 2008;Shet et al, 2006;Simon et al, 2002).…”

“…We observed low rates of individual major Pr mutations, all below 1%; our overall rate of 2% major Pr mutations is slightly less than many other studies in the United States (Castor et al, 2012;Huaman et al, 2011;Hurt et al, 2009;Little et al, 2002;MacVeigh et al, 2013;Readhead et al, 2012;Ross et al, 2007;Taniguchi et al, 2012;Truong et al, 2011;Weinstock et al, 2000;Weinstock et al, 2004;Wheeler et al, 2010;Yanik et al, 2012;Youmans et al, 2011). Although in the minority, persons with dual and triple class ARV resistance mutations were seen in 2% (8 patients) and 0.7% (3 patients), respectively.…”

“…The most commonly detected RT mutations in our study were M41L for NRTIs and K103N for NNRTIs, which are among the most frequently reported in many studies (Castor et al, 2012;Huaman et al, 2011;Hurt et al, 2009;Little et al, 2002;MacVeigh et al, 2013;Readhead et al, 2012;Ross et al, 2007;Taniguchi et al, 2012;Truong et al, 2011;Weinstock et al, 2004;Wheeler et al, 2010;Yanik et al, 2012;Youmans et al, 2011). We observed low rates of individual major Pr mutations, all below 1%; our overall rate of 2% major Pr mutations is slightly less than many other studies in the United States (Castor et al, 2012;Huaman et al, 2011;Hurt et al, 2009;Little et al, 2002;MacVeigh et al, 2013;Readhead et al, 2012;Ross et al, 2007;Taniguchi et al, 2012;Truong et al, 2011;Weinstock et al, 2000;Weinstock et al, 2004;Wheeler et al, 2010;Yanik et al, 2012;Youmans et al, 2011).…”

“…Based on United States Department of Health and Human Services (DHHS) guidelines, genotypic antiretroviral resistance testing (GART) was initially given CIII and DIII recommendations in 2000 for acutely-infected and chronically-infected treatment-naïve patients, (DHHS, 2007). For ARV treatment naïve individuals in the U.S., TDR mutation rates have ranged from about 5% to as high as 25% (Castor et al, 2012;Huaman et al, 2011;Hurt et al, 2009;Little et al, 1999;Little et al, 2002;MacVeigh et al, 2013;Readhead et al, 2012;Ross et al, 2007;Taniguchi et al, 2012;Truong et al, 2011;Weinstock et al, 2000;Weinstock et al, 2004;Wheeler et al, 2010;Yanik et al, 2012;Youmans et al, 2011). TDR has several important implications.…”