HPTN Bibliographic Record
Fogel JM, Sivay MV, Cummings V, Wilson EA, Hart S, Gamble T, Laeyendecker O, Fernandez RE, Del Rio C, Batey D S, Mayer KH, Farley JE, McKinstry L, Hughes JP, Remien RH, Beyrer C, Eshleman SH. HIV Drug Resistance in a Cohort of HIV-Infected Men Who Have Sex with Men in the United States. AIDS. 2019
OBJECTIVE: To analyze HIV drug resistance among men who have sex with men (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 multi-assay 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 multi-class 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. CONCLUSIONS: High prevalence of drug resistance was observed among MSM. Some had multi-class resistance, resistance to drugs used for pre-exposure 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 US.