Antiretroviral drug resistance among treatment-naïve HIV-1 infected individuals in Washington, DC

Background: When HIV-1 positive individuals engage in high-risk behaviors, the possibility of transmitting drug resistant variants of the HIV-1 virus increases. Recent literature has documented varied rates of HIV-1 genotypic mutations resulting in a reduction in viral susceptibility to anti-retroviral therapy (ART) among treatment-naïve individuals. The rates of genotypic resistance among treatment-naïve HIV-1-infected individuals in Washington, DC, the area with the highest rate of HIV/AID in the US, are poorly documented. A pilot study was designed to determine the rates of ART resistance in a retrospective sample of treatment-naïve individuals in Washington, DC. Methods: From January 1, 2005 to December 31, 2005, there were 231 new patients, 117 of who were HIV-1 treatment-naïve, and 49 who had HIV-1 genotypic analyses before the individuals voluntarily entered medical care. After correcting for missing medical charts and genotype reports, 42 treatment-naïve HIV-1 infected individuals were identified. Results: Preliminary results indicate that individuals in Washington, DC are infected with resistant HIV-1. Genotypic mutations are also present in the regions of the virus genome whose gene products are the targets for anti-retroviral drugs. Further analysis is underway to examine the rates for clinically relevant mutations, as well as the correlate factors associated with genotypic mutations (high-risk behaviors and demographic variables). Conclusions: These results have important public health implications and validate the need to further investigate the rates of resistance in metropolitan areas such as Washington, DC.