3rd International AIDS Society Conference on HIV Pathogenesis and Treatment Rio de Janeiro - July 24 - 27, 2005

HIGH RISK FOR TRANSMISSION OF DRUG-RESISTANT HIV VARIANTS AMONG HIV-INFECTED PATIENTS IN ROUTINE CLINICAL CARE

IAS Conf HIV Pathog Treat 2005 Jul 24-27;3rd: Abstract No. MoPp0203

Napravnik S.¹, Mikeal O.¹, McKaig R.G.², Matteson E.A.¹, Menezes P.¹, Eron Jr J.J.^1
1University of North Carolina at Chapel Hill, Chapel Hill, United States of America, ²National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, United States of America

INTRODUCTION: Since the transmission of antiretroviral (ARV) drug-resistant HIV variants limits antiretroviral therapy (ART) options, we assessed factors increasing the risk of transmitting HIV variants harboring mutations associated with reduced ARV drug susceptibility among HIV-infected patients receiving primary HIV care.

METHODS: The study population included 224 HIV-infected patients enrolled in the UNC-CFAR Cohort Study, who completed an in-person behavioral interview. Mutations associated with reduced ARV drug susceptibility were based on the International AIDS Society – USA Panel guidelines. High risk for transmission of resistance was measured as unprotected sexual activity in the prior 12 months (UPS), genotypic evidence of ARV drug resistance, detectable plasma HIV RNA (pVL >400 copies/mL) in the presence of ARV drug pressure, and incomplete ART adherence.

RESULTS: Most patients (91%) were ART-experienced. Among 170 patients taking ART at the time of interview, 60% reported incomplete ART adherence, and 48% had detectable pVL. Overall UPS in the prior 12-months was reported by 52% of patients; including 50% on ART with detectable pVL. Poor ART adherence was strongly associated with UPS (OR=2.2; 95%CI, 1.2, 3.9; p=0.01). Genotypes were available for 41% of patients (N=91). Resistance to at least 2 ARV drug classes was more common among patients reporting UPS than those who did not (67% vs 49%, p=0.09), as was the number of mutations (median 4 (IQR, 2, 7) versus 3 (IQR, 2, 5); p=0.08). Among patients reporting UPS with available genotypes (N=48), 69% had at least 1 protease inhibitor mutation, 77% nucleoside(tide) reverse transcriptase mutation, and 33% non-nucleoside reverse transcriptase mutation, and only 2% had no resistance mutations.

CONCLUSIONS: Although, the likelihood of transmitting drug-resistant HIV variants depends on a host of individual and viral factors, based on self-reported patient behaviors the risk of transmission of resistant HIV-1 may be high among HIV-infected patients in clinical care.

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Prevention | MoPp0203 | Sonia Napravnik
10.7 254 10.7 Sexual transmission

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