Abstract
Epidemiology of drug resistant HIV has focused on trends and less attention has been given to identification of factors, especially behaviors including substance use, in acquisition of drug-resistant HIV. From 2009 to 2012 The Metromates Study enrolled and followed for one year men who have sex with men (MSM) seeking testing for HIV in a community clinic in Los Angeles assessing those testing positive for acute and recent HIV infection. Behavioral data were collected via Computer-Assisted Self-Interview from 125 classified as newly HIV infected and 91 as chronically infected (newly HIV-diagnosed); specimens were available and viable for resistance testing for 154 of the 216 HIV positives with new diagnoses. In this community clinic we found prevalence of resistance among MSM with new HIV-diagnosis was 19.5% (n = 30/154) with no difference by recency of HIV infection. Sexual partnership characteristics were associated with resistance; those who reported transgendered sex partners had a higher prevalence of resistance as compared to those who did not report transgendered sex partners (40% vs. 17%; p value = 0.04), while those who reported having a main partner had a lower prevalence of drug resistance (12% vs. 24%; p value = 0.07). In multivariable analyses adjusting for HIV recency and antiviral use, reporting a main partner decreased odds [adjusted odds ratio (AOR) 0.34; 95% confidence interval (CI) 0.13–0.87], reporting a transgendered partnered increased odds (AOR = 3.37; 95% CI 0.95–12.43); and being African American increased odds of drug resistance (AOR = 5.63, 95%CI 1.41–22.38). This suggests African American MSM and TG individuals in Los Angeles represent pockets of exceptional risk that will require special approaches to prevention and care to enhance their own health and reduce their likelihood to support transmission of drug resistance in the US.
Highlights
Among those with a new diagnosis of HIV infection, some are infected by a strain of HIV-1 resistant to one or more drugs, known as primary or transmitted drug resistance (TDR) [1]
The prevalence of drug resistance of 19.5% among men who have sex with men (MSM) in Los Angeles with new HIV diagnosis is relatively high compared to other reports [20] even when the analysis is restricted to those with acute/recent HIV infection (16.1%)
Concerns that this high level of resistance may be due to underreporting previous use of ARVs are lessened because of our study design: our subjects were recruited after seeking HIV testing on their own at a community clinic
Summary
Among those with a new diagnosis of HIV infection, some are infected by a strain of HIV-1 resistant to one or more drugs, known as primary or transmitted drug resistance (TDR) [1]. The efficiency of such transmission between individuals is relatively low[2] but evidence is growing that such resistance can stem from untreated individuals and strains can persist in populations for many years[3, 4]. To contribute to understanding the role of substance use and other risk factors in acquisition of drug-resistant HIV we conducted a study of MSM with new HIV diagnoses in Los Angeles in a community clinic setting
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