Paper # 581 
Prevalence of Mutations Associated with Transmitted Drug Resistant HIV among BED Recent Versus Long-term Infections, US, 2006
Joseph Prejean*1, R Ziebell2, W Wheeler1, D Pieniazek1, J Johnson1, I Hall1, and Variant, Atypical and Resistant HIV Surveillance Group
1CDC, Atlanta, GA, US and 2The Ginn Group Inc, Peachtree City, GA, US
Background: Previous studies have shown that
transmitted drug resistance-associated mutations (TDRM) in HIV-1 are identified
more frequently in recent than in long-standing (LS) infections. We report
results from the US HIV surveillance system which collects population-based
data on all new diagnoses of HIV infection, HIV drug resistance, and serologic
algorithm for recent HIV seroconversion results using the HIV-1 Capture BED
assay in selected areas.
Methods: We analyzed cases of HIV newly diagnosed in
2006 from 10 states and one county that collect data on both recentness of
infection and antiretroviral resistance that were reported to the national HIV
surveillance system through June 2007. We merged results from BED testing of
remnant serum specimens with HIV-1 protease and reverse transcriptase (RT)
genetic sequence data from either remnant diagnostic serum specimens or
physician-ordered drug resistance tests. TDRM were identified using a mutation
list developed by Bennett et al. (2009) and modified for a largely subtype B
population by Wheeler et al. (submitted for publication). We used Χ2
and Fischer’s exact tests to examine differences in TDRM by recency of
infection.
Results: Data were obtained from 1,622 newly
diagnosed, drug-naïve persons. Among these, 416 (26%) had recent infections and
1,206 (74%) had LS infections or were diagnosed with AIDS within 6 months of
HIV diagnosis. Seventy-six (18.3%) infections classified as recent had TDRM and
166 (13.7%) infections classified as LS had TDRM (P =0.03). There
were no significant differences in persons with recent vs LS infection with
TDRM in protease or nucleoside reverse transcriptase inhibitors. For
non-nucleoside reverse transcriptase inhibitors (NNRTI), significantly more
individuals with recent infection had TDRM (50 (12.0%) recent vs 82 (6.8%) LS; P <0.01).
Ten (2.4%) persons with recent infections had 2 or more TDRM for NNRTI vs 11
(0.9%) with LS infections (P =0.04).
Conclusions: These results suggest that TDRM are
present using standard genotyping methods significantly more frequently in
persons with recent versus LS infections. This difference is largely driven by
NNRTI TDRM. The data may reflect the tendency of mutations to revert to
wild-type over time, but may also suggest that transmission of drug resistance
mutations may be increasing. Further investigation is needed to explain the
difference in TDRM among recent vs LS infections.
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