HIV drug resistance in a cohort of HIV-infected MSM in the United States

• Type of Material: Article
• Authors: Jessica M. Fogel, Johns Hopkins University; Mariya Sivay, Johns Hopkins University; Vanessa Cummings, Johns Hopkins University; Ethan A. Wilson, Fred Hutchinson Cancer Research Center; Stephen Hart, Frontier Science Foundation; Theresa Gamble, FHI 360; Oliver Laeyendecker, National Institute of Allergy and Infectious Diseases; Reinaldo E. Fernandez, Johns Hopkins University; Carlos del Rio, Emory University; D. Scott Batey, University of Alabama, Birmingham; Kenneth H. Mayer, Harvard Medical School; Jason E. Farley, Johns Hopkins University; Laura McKinstry, Fred Hutchinson Cancer Research Center; James P. Hughes, University of Washington; Robert H. Remien, NY State Psychiatric Institute and Columbia University; Chris Beyrer, Johns Hopkins Bloomberg School of Public Health; Susan H. Eshleman, Johns Hopkins University
• Language: English
• Date: 2020-01-01
• Publisher: LIPPINCOTT WILLIAMS & WILKINS
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: 2020
• License: Creative Commons Attribution-NonCommercial 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1097/QAD.0000000000002394
• Title of Journal or Parent Work: AIDS
• Volume: 34
• Issue: 1
• Start Page: 91
• End Page: 101
• Grant/Funding Information: This work was supported by the HIV Prevention Trials Network (HPTN) sponsored by the National Institute of Allergy and Infectious Diseases (NIAID), National Institute on Drug Abuse (NIDA), and Office of AIDS Research, of the National Institutes of Health (NIH) [UM1-AI068613 (Eshleman); UM1-AI068617 (Donnell); and UM1-AI068619 (Cohen/El-Sadr)]. Additional support was provided by the Division of Intramural Research, NIAID (Laeyendecker).
• Keywords: BLACK-MEN; TRANSMISSION; phylogenetic analysis; RILPIVIRINE; ADULTS; SEX; MSM; PREVENTION; CABOTEGRAVIR; HIV drug resistance; Virology; Life Sciences & Biomedicine; Science & Technology; Immunology; PHASE 2B; Infectious Diseases; HPTN 078; United States
• Research Categories: Health Sciences, Public Health; Biology, Virology; Health Sciences, Immunology

Abstract

Objective: To analyze HIV drug resistance among MSM recruited for participation in the HPTN 078 study, which evaluated methods for achieving and maintaining viral suppression in HIV-infected MSM.Methods:Individuals were recruited at four study sites in the United States (Atlanta, Georgia; Baltimore, Maryland; Birmingham, Alabama; and Boston, Massachusetts; 2016-2017). HIV genotyping was performed using samples collected at study screening or enrollment. HIV drug resistance was evaluated using the Stanford v8.7 algorithm. A multiassay algorithm was used to identify individuals with recent HIV infection. Clustering of HIV sequences was evaluated using phylogenetic methods.Results:High-level HIV drug resistance was detected in 44 (31%) of 142 individuals (Atlanta: 21%, Baltimore: 29%, Birmingham: 53%, Boston: 26%); 12% had multiclass resistance, 16% had resistance to tenofovir or emtricitabine, and 8% had resistance to integrase strand transfer inhibitors (INSTIs); 3% had intermediate-level resistance to second-generation INSTIs. In a multivariate model, self-report of ever having been on antiretroviral therapy (ART) was associated with resistance (P=0.005). One of six recently infected individuals had drug resistance. Phylogenetic analysis identified five clusters of study sequences; two clusters had shared resistance mutations.Conclusion:High prevalence of drug resistance was observed among MSM. Some had multiclass resistance, resistance to drugs used for preexposure prophylaxis (PrEP), and INSTI resistance. These findings highlight the need for improved HIV care in this high-risk population, identification of alternative regimens for PrEP, and inclusion of integrase resistance testing when selecting ART regimens for MSM in the United States.