AIDS

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AIDS:
doi: 10.1097/01.aids.0000252059.85236.af
Epidemiology and Social

Routine surveillance for the detection of acute and recent HIV infections and transmission of antiretroviral resistance

Truong, Hong-Ha Ma,b; Grant, Robert Ma,b; McFarland, Willia,c; Kellogg, Timothyc; Kent, Charlottec; Louie, Brianc; Wong, Ernestc; Klausner, Jeffrey Da,c

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Abstract

Objective: To estimate the rate of acute and recent HIV infections and the prevalence of primary antiretroviral resistance.

Design, setting, and subjects: A consecutive sample of individuals presenting for HIV testing at the San Francisco municipal sexually transmitted diseased (STD) clinic in 2004 (n = 3789).

Main outcome measures: HIV antibody-positive specimens were screened by BED IgG capture enzyme immunoassay to identify recent infections. HIV antibody-negative specimens were screened by nucleic acid amplification testing (NAAT) to detect acute infections. Newly detected infections were genotyped to detect primary antiretroviral resistance.

Results: There were 11 acute and 44 recent HIV infections among the total 136 newly detected cases. NAAT increased case identification by 8.08% over standard antibody testing. Acute HIV infections were associated with having a known HIV-positive partner, and a history of hepatitis B, syphilis, and chlamydia. The prevalence of primary antiretroviral resistance was 13.2%, with drug-resistant mutations detected in 17 of 129 cases genotyped. Mutations conferring resistance to non-nucleoside reverse transcriptase inhibitors (NNRTI) were present in 11 of 17 cases.

Conclusion: The integration of HIV nucleic acid amplification, recent infection, and antiretroviral resistance testing enhanced HIV/STD surveillance. The high proportion of NNRTI mutations detected suggests they may be more common in source partners or more fit for transmission than other forms of drug-resistant HIV-1. Primary antiretroviral resistance monitoring in STD clinic patients may guide the selection of treatment and post-exposure prophylaxis regimens active against viruses being transmitted in the community, and provide health departments with surveillance data in a sentinel population at risk of HIV transmission.

© 2006 Lippincott Williams & Wilkins, Inc.

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