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337939
Transmitted Drug Resistance and Time of HIV Infection, New York State, 2006-2013


Tuesday, November 3, 2015

Zhengyan Wang, PhD, AIDS Institute, New York State Department of Health, Albany, NY
Emily Walits, School of Public Health – Albany, NY, University at Albany, Rensselaer, NY
Daniel Gordon, PhD, AIDS Institute, New York State Department of Health, Albany, NY
Bridget Anderson, PhD, Bureau of HIV/AIDS Epidemiology, AIDS Institute, New York State Department of Health, Albany, NY
Deepa Rajulu, Master of Science, Office of Public Health, New York State Department of Health, Albany, NY
Ling Wang, PhD, AIDS Institute, New York State Department of Health, Albany, NY
Lou Smith, MD, MPH, Department of Epidemiology, Evaluation, and Research, AIDS Institute, New York State Department of Health, Albany, NY
Background: Transmitted drug resistance (TDR) occurs when a person is infected with a resistant strain of HIV. Antiretroviral drug resistance results in persons newly diagnosed with HIV may reflect transmissions that occurred in previous years. This study evaluates the need to classify newly diagnosed cases by recency of infection in order to appropriately and accurately determine the prevalence of TDR.

Methods: Newly diagnosed cases from 1/2006-9/2013 in the NYS HIV surveillance system were classified as "recent", "longstanding", or "unknown" infections based on BED result and AIDS diagnosis. All cases were linked with genotypic resistance test results. The presence of TDR was determined by comparing the CDC's TDR mutation (TDRM) list to mutations in protease and reverse transcriptase sequences analyzed using in-house software. TDRM prevalence ratios in recent and longstanding cases were compared.

Results: Among 29,515 newly diagnosed cases, 13,015 (44%) had a resistance test within 3 months of diagnosis. 2,016 were classified as recent, 8,703 were classified as longstanding. The prevalence of TDR among recently infected cases rose from 17% in 2006 to 24% in 2013 and from 13% to 18% in longstanding cases. Prevalence of TDRM was significantly higher among recently infected cases across all subgroups: sex, age, race/ethnicity, risk group, and geographic location.

Conclusions: Recency of infection is an important factor in TDR prevalence among persons newly-diagnosed with HIV. Higher prevalence of TDR in  recently infected persons suggests a growing number of transmissions are due to non-ARV naïve persons with inadequately controlled infections.

Learning Areas:

Epidemiology

Learning Objectives:
Demonstrate the importance of using recency of infection when analyzing transmitted HIV drug resistance.

Keyword(s): HIV/AIDS

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the principal investigator of the federally funded National HIV Surveillance System cooperative agreement, which includes the Molecular HIV Surveillance component. Additionally I am the PI for numerous other federal or academic grants. I direct the Bureau of HIV/AIDS Epidemiology within the New York State Department of Health and serve as the elected Chair of the Council for State and Territorial Epidemiologists HIV Subcommittee.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

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