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Hard to Pinpoint Factors Favoring Infection With Resistant HIV
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5th European HIV Drug Resistance Workshop
Cascais, Portugal
March 28, 2007
Mark Mascolini
Being gay, having at least 12 years of education, and having a viral load between 10,000 and 100,000 copies favored primary infection with resistant virus in a multistate US study [1]. Compared with whites, African Americans had a lower risk of infection with resistant HIV and Hispanics had a higher risk. But none of these variables independently predicted primary infection with virus bearing resistance mutations.
The study involved 228 antiretroviral-naive adults seen from August 2005 through December 2006 at 19 sites in Florida (6), Massachusetts (4), California (2), Colorado, Michigan, North Carolina, New York, Texas, New Jersey, and Nevada (1 each). The group's age averaged 37.1 years, about 80% were men, 37% were Caucasian, 40% African American, and 17% Hispanic. Eight in 10 people said they got infected during sex, and median self-reported time since HIV diagnosis measured 1 year. While 38% of the cohort had a CD4 count under 200 cells, one third had a count between 200 and 350. Half of the study group had 12 or more years of education.
In results reflecting other recent US studies, slightly more than 12% of this far-flung cohort carried virus with at least one resistance mutation, including 9.8% with mutations conferring resistance to nonnucleosides, 4.5% with nucleoside mutations, and 1.8% with mutations to protease inhibitors. Only 2.2% had mutations rendering virus resistant to two antiretroviral classes, and 1% had triple-class resistance mutations.
Compared with whites, African Americans had a 20% lower risk of infection with resistant HIV (odds ratio [OR] 0.8, 95% confidence interval [CI] 0.3 to 1.9) and Hispanics had a 50% higher risk (OR 1.5, 95% CI 0.5 to 4.3). Since the confidence interval crossed 1.0 in both comparisons, these risk differences lacked statistical significance.
People with 12 or more years of schooling had a doubled risk of infection with resistant virus, and people with a viral load from 10,000 to 100,000 had a 40% higher risk than those with a lower load. Both of these risk differences fell short of statistical significance. A doubled risk of infection with resistant virus in men who have sex with men nearly reached statistical significance (95% CI 0.9 to 4.5). Although earlier findings on gay sex and transmission of resistant virus have proved inconsistent, the authors believe this body of evidence "suggests an association between male-male sexual transmission and presence of transmitted drug resistance."
In Madrid rates of infection with resistant HIV appear to be on the rise. A survey of 85 antiretroviral-naive people charted a spurt in primary resistance from 9.4% through the end of 2005 to 14% by the end of 2006 [2].
References
1. Hu H, Huang H, Sax P, et al. The prevalence of antiretroviral drug resistance in HIV-infected patients prior to initiation of antiretroviral therapy. 5th European HIV Drug Resistance Workshop. March 28-30, 2007. Cascais, Portugal. Abstract 19.
2. Garcia R, Cianchetta M, Paravissini A, et al. Increase in prevalence of primary mutations in naive HIV patients in Spain. 5th European HIV Drug Resistance Workshop. March 28-30, 2007. Cascais, Portugal. Abstract 6.
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