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

Christina Gagliardo, Ava Brozovich, Jeffrey Birnbaum, Anita Radix, Marc Foca, John Nelson, Lisa Saiman, Michael Yin, Elektra Carras-Terzian, Emily West, Natalie Neu

Research output: Contribution to journalArticlepeer-review

13 Scopus citations

Abstract

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/L. 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/L. Overall, 191 (58%) subjects started ART. The mean CD4 count at ART initiation was 261 cells/L before and 363 cells/L 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.

Original languageEnglish (US)
Pages (from-to)865-872
Number of pages8
JournalClinical Infectious Diseases
Volume58
Issue number6
DOIs
StatePublished - Mar 2014
Externally publishedYes

Keywords

  • HIV
  • adolescents
  • antiretroviral therapy
  • genotypic resistance
  • youth

ASJC Scopus subject areas

  • Microbiology (medical)
  • Infectious Diseases

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