A Multicenter Study of Initiation of Antiretroviral Therapy and Transmitted Drug Resistance in Antiretroviral-Naive Adolescents and Young Adults With HIV in New York City

Background. In December 2009, the Department of Health and Human Services guidelines for initiation of antiretroviral therapy (ART) changed to include patients with CD4 counts between 350 and 500 cells/μL. The aims of this study were to assess uptake of this recommendation in ART-naive youth with hu...

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Bibliographic Details
Published in:Clinical infectious diseases 2014-03, Vol.58 (6), p.865-872
Main Authors: Gagliardo, Christina, Brozovich, Ava, Birnbaum, Jeffrey, Radix, Anita, Foca, Marc, Nelson, John, Saiman, Lisa, Yin, Michael, Carras-Terzian, Elektra, West, Emily, Neu, Natalie
Format: Article
Language:English
Subjects:
Adolescent
Adolescents
Adult
AIDS
Anti-HIV Agents - administration & dosage
Antibiotics. Antiinfectious agents. Antiparasitic agents
Antiretroviral drugs
Antiretrovirals
Antiviral agents
Assisted reproductive techniques
Biological and medical sciences
Cohort Studies
Drug resistance
Drug Resistance, Viral - genetics
Epidemiology
Female
Genetic mutation
HIV
HIV 1
HIV infections
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - virology
HIV-1 - drug effects
HIV-1 - genetics
HIV/AIDS
Human immunodeficiency virus
Human viral diseases
Humans
Immunodeficiencies
Immunodeficiencies. Immunoglobulinopathies
Immunopathology
Infectious diseases
Male
Medical sciences
Mutation
New York City - epidemiology
Pharmacology. Drug treatments
Retrospective Studies
RNA
Viral diseases
Viral diseases of the lymphoid tissue and the blood. Aids
Young Adult
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Summary:Background. In December 2009, the Department of Health and Human Services guidelines for initiation of antiretroviral therapy (ART) changed to include patients with CD4 counts between 350 and 500 cells/μL. The aims of this study were to assess uptake of this recommendation in ART-naive youth with human immunodeficiency virus (HIV) and to describe the epidemiology of transmitted genotypic drug resistance mutations (DRMs) in this population. Methods. A multicenter, retrospective cohort study of ART initiation in ART-naive youth was performed. Eligible subjects were 13–25 years of age, were diagnosed with HIV within 1 year of presentation to care at the study sites, and presented to care from January 2007 to June 2011. Results. Of 685 potential subjects identified, 331 (49%) fulfilled inclusion criteria. Mean CD4 count at presentation to care was 452 cells/μL. Overall, 191 (58%) subjects started ART. The mean CD4 count at ART initiation was 261 cells/μL before and 363 cells/μL after the 2009 guideline change (P < .0001). Of 212 (64%) subjects with resistance testing available prior to ART initiation, 38 (18%) subjects had a major DRM and an increased proportion of resistance was seen in later study years. Conclusions. Our study demonstrated an uptake in recently changed guideline recommendations to treat HIV-infected individuals at higher CD4 counts and reinforces the importance of performing resistance testing at entry into care, as 18% of our population had major DRMs prior to initiation of ART.
ISSN:1058-4838
1537-6591
DOI:10.1093/cid/ciu003