414. Analysis of Prevalence and Characteristics of Transmitted HIV-1 Drug Resistance in Primary Infections in a Cohort of Acute and Recently Infected Men in New York
Session: Poster Abstract Session: HIV - Antiretroviral Therapy
Friday, October 21, 2011
Room: Poster Hall B1
Handouts
  • RN IDSA PHIV poster.pdf (142.3 kB)
  • Background:

    Cohort studies have indicated that that the prevalence of HIV drug resistance among newly infected individuals varies by geographic location and behavioural risk factor for HIV infection. The general trend appears to be that the prevalence of HIV drug resistance is increasing, particularly among men who have sex with men (MSM). It is thought that the presence of drug resistant viral strains in acute HIV infection greatly reduces the likelihood of long-term viral suppression but additional studies of drug-naïve, acutely-infected patients are needed.

    Methods:

    The study population consisted of treatment-naïve subjects enrolled in a clinical trial examining immunologic control of acute and recent HIV infection performed at NYU Medical Center, New York City, between 2004-2009. We identified 64 new HIV infections, which were stratified into acute, recent and early-established infection by use of the serologic testing algorithm for recent HIV seroconversion (STAHRS). Plasma samples from the first study visit were analysed for drug resistance by nucleotide sequencing of the reverse transcriptase and protease genes of plasma virus (genotyping).

    Results:

    Only four (6%) of 64 individuals with incident HIV infection had evidence of reverse transcriptase or protease gene mutations associated with drug resistance. All four were MSM. Two of the four were successfully treated while two opted not to receive treatment. Three had resistance to non-nucleoside reverse transcriptase inhibitors and one had resistance to a protease inhibitor with none demonstrating resistance against more than one class of antiretroviral drug. The L63P mutation was most commonly observed.

    Conclusion:

    It is unclear why the prevalence of transmitted resistance among New York City MSM with acute, recent and early established HIV infection was lower than has been reported in other studies from other geographic locales. The individuals we identified with incident HIV infection were all MSM and it is possible that the persons from whom our patients acquired HIV had a lower prevalence of drug resistance. Further work is required to elucidate the epidemiologic significance of the low prevalence of transmitted drug resistance. Efforts to improve treatment compliance must be escalated.


    Subject Category: H. HIV/AIDS and other retroviruses

    Ruvandhi Nathavitharana, MD MPH , Demetre Daskalakis, MD, Richard Hutt, RN, Michael Marmor, PhD and Fred Valentine, MD, New York University School of Medicine, New York, NY

    Disclosures:

    R. Nathavitharana, None

    D. Daskalakis, None

    R. Hutt, None

    M. Marmor, None

    F. Valentine, None

    Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.