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AIDS. 2017 Oct 23;31(16):2235-2244. doi: 10.1097/QAD.0000000000001611.

Pretreatment integrase strand transfer inhibitor resistance in North Carolina from 2010-2016.

Author information

1
aDivision of Global Health and Infectious Diseases bDepartment of Epidemiology, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill cDivision of HIV/AIDS, North Carolina Department of Public Health, Raleigh, North Carolina, USA.

Abstract

OBJECTIVE:

We sought to define the prevalence of pretreatment integrase strand transfer inhibitor (INSTI) resistance and assess the transmission networks of those with pretreatment INSTI resistance.

DESIGN:

A retrospective cohort study of HIV-positive patients with genotypic resistance testing sent to a single referral laboratory in North Carolina between 2010 and 2016.

METHODS:

We linked genotype and public health data for in-care HIV-positive individuals to determine the prevalence of INSTI resistance among treatment-naive (defined as those with a first genotype ā‰¤3 months after diagnosis) and treatment-experienced (defined as those with a first genotype >3 months after diagnosis) patients. We performed molecular and phylogenetic analyses to assess whether pretreatment INSTI resistance mutations represented clustered HIV transmission.

RESULTS:

Of 8825 individuals who contributed sequences for protease, reverse transcriptase, or INSTI genotypic resistance testing during the study period, 2784 (31%) contributed at least one sequence for INSTI resistance testing. Of these, 840 were treatment-naive individuals and 20 [2.4%, 95% confidence interval (CI): 1.5, 3.6%] had INSTI mutations; only two (0.2%, 95% CI: 0.02, 0.9%) had major mutations. Of 1944 treatment-experienced individuals, 9.6% (95% CI: 8.3, 11.0%) had any INSTI mutation and 7.0% (95% CI: 5.9, 8.3%) had major mutations; the prevalence of INSTI mutations among treatment-experienced patients decreased overtime (Pā€Š<ā€Š0.001). In total 12 of 20 individuals with pretreatment INSTI mutations were part of 10 molecular transmission clusters; only one cluster shared identical minor mutations.

CONCLUSION:

The prevalence of major pretreatment INSTI resistance is very low. Pretreatment INSTI mutations do not appear to represent clustered HIV transmission.

PMID:
28991024
DOI:
10.1097/QAD.0000000000001611
[Indexed for MEDLINE]

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