Background: Resistance to antiretroviral medications limits treatment options and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance among HIV-infected persons in Washington, DC.
Methods: We analyzed resistance data in the DC Cohort, a longitudinal observational study of HIV-infected persons in care at 13 clinics in Washington, DC. Participants with at least one genotype between 1999 and 2014 were included (n=3,411; 52% of Cohort). Using the 2014 IAS-USA guidelines, we measured transmitted drug resistance (TDR) in treatment-naļve persons (n=1,503), subsequently acquired resistance (ADR, n=309), and cumulative resistance (CDR, n=3,411), including point mutations, resistance to drug classes, and trends over time. We used logistic regression to assess associations between patient demographics and resistance.
Results: Most participants were male (74%), black (81%) and infected through male-to-male sex (MSM) (40%) or heterosexual sex (32%). Prevalence of TDR was 20%; ADR was 40%. From 2006 to 2014, TDR and ADR increased; however, CDR decreased, likely due to increased testing of treatment-naļve patients (Figure). In 2014, CDR to any drug was 45%: 30% for NRTIs, 29% for NNRTIs, and 16% for PIs. Most common mutations were M184I/V (25%) and K103N/S (21%). In multivariable analysis of CDR, heterosexuals (OR: 0.82; 95%CI: 0.68-0.99), persons privately insured (OR: 0.65; 95%CI: 0.53-0.80), and those cared for at community-based clinics (CBCs) (OR: 0.68; 95%CI: 0.58-0.81) were less likely to have resistance to any drug compared to MSM, publicly-insured, and persons cared for at hospital-based clinics, respectively. IDUs were more likely to have TDR than MSM (OR: 1.8; 95%CI: 0.95-3.3). ADR was less common among women (OR: 0.54; 95%CI: 0.32-0.92) and persons tested at CBCs (OR: 0.52; 95%CI: 0.32-0.82) and more common among the privately insured (OR: 2.2; 95%CI: 1.2-4.0).
Conclusion: In this urban cohort of HIV-infected persons in care, almost half of participants tested had evidence of CDR, and TDR was increasing. Timely genotype testing and interventions to improve adherence may help minimize resistance in this population, particularly among MSM and IDUs.
D. Parenti, None
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