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  18th HIV Drug Resistance Workshop
June 9-12 2009
Ft Myers Florida
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STD History Tied to Infection With Resistant HIV in San Francisco
  Mark Mascolini
XVIII International Drug Resistance Workshop, June 9-13, 2009, Fort Myers, Florida
Recent sexually transmitted disease (STD) almost doubled the risk of infection with antiretroviral-resistant HIV among San Franciscans who picked up the retrovirus from 2004 through 2006, according to citywide surveillance results [1]. Infection with resistant HIV remained stable at rates between 12% and 16% across the 3 study years.
San Francisco's Department of Public Health made routine antiretroviral resistance testing part of its HIV/STD surveillance program to help guide clinicians in planning an appropriate regimen for people infected with resistant HIV. Genotyping is performed whenever someone has a positive HIV test upon voluntary counseling and testing at the municipal STD clinic.
This study involved 9691 people tested for HIV from January 2004 through December 2006. The population included 8225 men (85%), 1331 women (14%), and 124 transgendered people (1%). Samples with a negative result on standard enzyme-linked immunoassay got checked for acute infection through HIV RNA pooling.
Over the 3 study years, 377 people (4%) had a positive HIV test, including 29 (8% of 377) with acute HIV infection. Genotyping spotted resistance mutations in 50 samples (13% of 377). Mutation prevalence did not change significantly during the study: 11.9% in 2004, 15.9% in 2005, and 13.0% in 2006 (P = 0.75).
Nineteen people with drug-resistant HIV (38% of 50) reported having an STD within the past 2 years. Multivariate statistical analysis determined that recent STD strongly predicted infection with resistant virus, almost doubling the risk (adjusted odds ratio 1.92, P = 0.06).
Hong-Ma Truong and coworkers identified 28 samples (56% of 50) bearing nonnucleoside-induced mutations, 23 (46%) with nucleoside mutations, 11 (22%) with protease inhibitor (PI) mutations, 4 (8%) with nucleoside plus nonnucleoside mutations, 1 each (2%) with nucleoside plus PI mutations or nonnucleoside plus PI mutations, and 3 (6%) with triple-class resistance. Truong and colleagues speculated that the high rate of transmitted nonnucleoside mutations suggests common source partners or easier transmission of nonnucleoside-resistant HIV. Besides helping physicians pick an effective initial regimen, the researchers believe San Francisco's resistance testing program gives the health department valuable surveillance data in a sentinel population.
1. Truong HM, Kellogg T, McFarland W, Klausner J, Louie B, Grant RM. Integration of routine HIV-1 drug resistance testing into the San Francisco HIV/STD surveillance program. XVIII International Drug Resistance Workshop. June 9-13, 2009. Fort Myers, Florida. Abstract 68.