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. 2017 Sep 11;10(1):474.
doi: 10.1186/s13104-017-2764-9.

Prevalence and trends in transmitted and acquired antiretroviral drug resistance, Washington, DC, 1999-2014

Annette M Aldous  1 , Amanda D Castel  1 , David M Parenti  2 ; DC Cohort Executive Committee
Collaborators, Affiliations

Prevalence and trends in transmitted and acquired antiretroviral drug resistance, Washington, DC, 1999-2014

Annette M Aldous et al. BMC Res Notes. .

Abstract

Background: Drug resistance limits options for antiretroviral therapy (ART) and results in poorer health outcomes among HIV-infected persons. We sought to characterize resistance patterns and to identify predictors of resistance in Washington, DC.

Methods: We analyzed resistance in the DC Cohort, a longitudinal study of HIV-infected persons in care in Washington, DC. We measured cumulative drug resistance (CDR) among participants with any genotype between 1999 and 2014 (n = 3411), transmitted drug resistance (TDR) in ART-naïve persons (n = 1503), and acquired drug resistance (ADR) in persons with genotypes before and after ART initiation (n = 309). Using logistic regression, we assessed associations between patient characteristics and transmitted resistance to any antiretroviral.

Results: Prevalence of TDR was 20.5%, of ADR 40.5%, and of CDR 45.1% in the respective analysis groups. From 2004 to 2013, TDR prevalence decreased for nucleoside and nucleotide analogue reverse transcriptase inhibitors (15.0 to 5.5%; p = 0.0003) and increased for integrase strand transfer inhibitors (INSTIs) (0.0-1.4%; p = 0.04). In multivariable analysis, TDR was not associated with age, race/ethnicity, HIV risk group, or years from HIV diagnosis.

Conclusions: In this urban cohort of HIV-infected persons, almost half of participants tested had evidence of CDR; and resistance to INSTIs was increasing. If this trend continues, inclusion of the integrase-encoding region in baseline genotype testing should be strongly considered.

Keywords: Acquired drug resistance; Antiretroviral therapy; Cumulative drug resistance; DC; Drug resistance; HIV; Prevalence; Transmitted drug resistance; Washington.

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Figures

Fig. 1
Fig. 1
Composition of DC Cohort analysis groups, Washington DC, 1999–2014. CDR, cumulative drug resistance; TDR, transmitted drug resistance; ADR, acquired drug resistance; DRM, drug-resistant mutation; ART, antiretroviral therapy
Fig. 2
Fig. 2
Most prevalent drug-resistant mutations for each analysis group by drug class, Washington DC, 1999–2014. NRTI, nucleoside/nucleotide analogue reverse transcriptase inhibitor (top 4); NNRTI, nonnucleoside reverse transcriptase inhibitor (top 4); PI, protease inhibitor (top 4); EI, entry/fusion inhibitor (top 2); INSTI, integrase strand transfer inhibitor (top 2)
Fig. 3
Fig. 3
Trends in antiretroviral resistance by drug class, Washington DC, 2004–2013. TDR, transmitted drug resistance; ADR, acquired drug resistance; CDR, cumulative drug resistance. Results for 2014 are not shown due to incomplete data at the time of analysis
See this image and copyright information in PMC

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