Background:  Given the elevated potential for transmission of antiretroviral drug-resistant virus (TDR) to newly infected individuals, a deeper understanding of the baseline resistance patterns present in hard-to-reach adolescent men of color who have sex with men is required. In 2004, the Health Resources and Services Administration (HRSA), through the Special Projects of National Significance Program funded 8 demonstration projects to develop and evaluate service models designed to reach HIV-infected adolescent men of color who have sex with men who were not engaged in clinical care and to link them to appropriate clinical, supportive, and preventive services. The purpose of this analysis is to characterize TDR patterns among these ARV-naïve men.

Methods:  Genotypic data collected as part of routine care for participants ages 13 to 24 enrolled in the prospective client-level evaluation from 4 sites were analyzed. Univariate, bivariate, and multivariable methods were used to describe the sample and characteristics associated with the presence of common resistance patterns. Analyses were conducted with Stata version 9.0se (College Station, Texas).

Results:  Of the 224 participants, 86 (38.4%) had data available for resistance analysis prior to receipt of ARV. The majority of this sample was African American (84.9%), between 19 and 22 years (61.9%), and had been enrolled in care <3 months (84.9%). Overall, 12% had CD4 counts <200; 21.3% had a viral load >100,000 at baseline. Major surveillance drug resistance mutations were present in 15 subjects (17.4%):  9 (10.5%) had NNRTI mutations (4 had K103N); 4 (4.7%) had NRTI mutations; 3 (3.5%) had PI mutations (all L90M); and 1 participant demonstrated cross-class resistance to both NRTI and NNRTI, including harboring a K65R mutation. Compared with participants who had no resistance on evaluation, for those with any surveillance drug resistance mutations, ARV resistance was more likely if they were <21 years old (73.3% vs 59.4%) and less likely if they reported never using amphetamines or other stimulants (0% vs 13.4%) and cocaine or crack (0% vs 14.7%).

Conclusions:  This is the largest sample to date examining rates of TDR in a geographically diverse sample of HIV⁺ adolescent men of color who have sex with men. The rate of TDR found in this cohort study is similar to those reported among adult populations in the United States but is especially concerning given the young age of this sample and the potential need for long term use of antiretroviral therapy. This high rate of TDR underscores the critical roles of both early case identification, as well as secondary prevention.