13th Annual Conference of the British HIV Association 29 March–1 April 2007, Brighton, UK

ACQUISITION OF TRANSMITTED DRUG RESISTANT HIV-1 INFECTION IS ASSOCIATED WITH THE PRESENCE OF SEXUALLY TRANSMITTED INFECTIONS

HIV Med 2007; 8(Suppl. 1):5 (abstract no. O20)

Kate Nambiar¹, David Pao¹, Darshan Sudarshi¹, Gary Murphy², John Parry², Iain Reeves¹, Gillian Dean¹, Deenan Pillay³ and Martin Fisher^1
1Department of HIV and GUM, Brighton and Sussex University Hospitals NHS Trust, Brighton, UK, ²Department of HIV and STDs, Health Protection Agency, Colindale, London, UK, ³Department of Virology, University College and Royal Free Hospital Medical School, London, UK

AIM: To determine if transmitted drug resistance (TDR) in primary HIV-1 infection (PHI) is associated with sexually transmitted infections (STIs).

METHODS: PHI cases from 2000 to 2005 were identified. PHI was diagnosed by: negative HIV antibody within 6 months, evolving antibody or western blot, negative antibody but positive antigen and/or RNA, or incident infection on the Serological Testing Algorithm for Recent HIV Seroconversion (STARHS). Genotypic resistance testing was undertaken at the time of diagnosis and TDR was determined by the presence of any primary mutations. We recorded STI diagnoses made at or within 3 months of HIV diagnosis.

RESULTS: A total of 184 cases of PHI were identified (95% male, 96% of whom were MSM). 30 (16%) had TDR (14 NRTI, 12 NNRTI, 2 PI and two to multiple classes). 142 (76%) underwent STI screening with one or more STIs diagnosed in 59 (42%) (24 gonorrhoea, 12 chlamydia, 32 non-specific urethritis, three primary syphilis, five primary Herpes and one trichomoniasis). STIs were seen more frequently in the TDR group (61 versus 37%; P<0.05)

CONCLUSION: TDR is associated with the presence of STIs. This could be due to STIs facilitating transmission of HIV, thereby overcoming fitness barriers. Alternatively it could be explained by an association between risk behaviour, STIs and poor adherence to antiretrovirals among individuals in sexual networks. Therefore, strategies to improve STI diagnosis and management may decrease TDR as well as overall HIV transmission. The high prevalence of STIs at PHI, alongside the known impact of STIs on genital HIV RNA, supports the need for close cooperation between HIV and STI services for newly infected individuals.

2007-03-29
O20

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