TY - JOUR
T1 - 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
AU - Gagliardo, Christina
AU - Brozovich, Ava
AU - Birnbaum, Jeffrey
AU - Radix, Anita
AU - Foca, Marc
AU - Nelson, John
AU - Saiman, Lisa
AU - Yin, Michael
AU - Carras-Terzian, Elektra
AU - West, Emily
AU - Neu, Natalie
N1 - Funding Information:
Financial support. C. G. is supported by the Columbia University T32-AI007531 postdoctoral Pediatric Infectious Disease Fellowship training grant. Potential conflicts of interest. All authors: No reported conflicts.
PY - 2014/3
Y1 - 2014/3
N2 - 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.
AB - 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.
KW - HIV
KW - adolescents
KW - antiretroviral therapy
KW - genotypic resistance
KW - youth
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U2 - 10.1093/cid/ciu003
DO - 10.1093/cid/ciu003
M3 - Article
C2 - 24429431
AN - SCOPUS:84895741786
SN - 1058-4838
VL - 58
SP - 865
EP - 872
JO - Clinical Infectious Diseases
JF - Clinical Infectious Diseases
IS - 6
ER -