CDC Finds 1 in 6 Newly Diagnosed With HIV Had Resistant Virus in 2007
17th CROI, February 16-19, 2010, San Francisco

Analysis of almost 2500 viral sequences from US residents with newly diagnosed, untreated HIV infection found one or more resistance mutations in 16% [1]. In this 10-state 2007 Centers for Disease Control (CDC) survey, resistance mutations were most common blacks, gay men, and people between 20 and 49 years old, but resistance rates did not differ significantly by race, HIV transmission risk, or age.

Using the latest World Health Organization surveillance list of transmitted resistance mutations, the CDC team analyzed 2480 HIV-1 sequences from 10,496 untreated people (24%) diagnosed with HIV in Colorado, Illinois, Louisiana, Michigan, Minnesota, Mississippi, North Carolina, Pennsylvania, South Carolina, and Virginia. Of the people whose virus was sequenced, 75% were male, 83% were 20 to 49 years old, 59% were non-Hispanic blacks, and 50% were gay men.

One or more resistance mutations could be detected by standard sequencing in 388 people (16% of 2480). Assays that detect minority populations of virus probably would have found more resistance mutations. Nonnucleoside mutations appeared in 202 sequences (52% of them K103N), nucleoside mutations in 152 (32% of them M41L), and protease inhibitor mutations in 103 (35% of them L90M).

Of the 388 sequences bearing resistance mutations, 332 (86%) had mutations conferring resistance to a single antiretroviral class, 43 (11%) had mutations that make HIV resistant to two classes, and 13 (3%) had mutations conferring triple-class resistance.

Among 1163 gay men studied, 15% had resistant virus, as did 16% of 1461 blacks, 17% of 711 whites, and 13% of 246 Hispanics. Resistance rates did not vary significantly by age:

• Under 20: 18% of 170 people
• 20 to 29: 16% of 900 people
• 30 to 39: 14% of 637 people
• 40 to 49: 17% of 519 people
• 50 to 59: 14% of 199 people
• Over 59: 13% of 55 people

Among 1925 people with a known country of origin, 1709 (89%) came from the United States or one of its dependencies and 216 came from other countries. Transmitted resistance prevalence was 16% in the US group and 11% in the non-US group.

Although these data may not reflect trends across the United States (for example, New York and California were not part of the survey), they confirm a persistently high rate of transmitted drug resistance. The CDC team found no significant differences in resistance rates by race or ethnicity, gender, age, or HIV transmission category.

Reference

1. Kim D, Wheeler W, Ziebell R, et al. Prevalence of transmitted antiretroviral drug resistance among newly-diagnosed HIV-1-infected persons, US, 2007. 17th Conference on Retroviruses and Opportunistic Infections. February 16-19, 2010. San Francisco. Abstract 580.