by Carolyn Chu, MD, MSc, AAHIVS, AAHIVM Chief Medical Officer

May 24, 2022

Featured Literature:
Hugueley B, McClung RP, Saduvala N, et. al.  Baseline HIV drug-resistance testing: 12 U.S. jurisdictions, 2014-2019.  AIDS.  2022 Jun 1; 36(7): 1039-1043.  PMID: 35142706

This study examined patterns in reported baseline ARV drug resistance testing among 12 select U.S. jurisdictions (Alabama, California, Connecticut, D.C., Iowa, Michigan, New York, Rhode Island, South Carolina, Texas, Washington, and Wisconsin).  Authors analyzed National HIV Surveillance System data reported to CDC regarding persons 13 years of age and over who were diagnosed with HIV during 2014-2019 (n = 93,666).  49.2% of individuals had a PR/RT (with or without integrase) sequence reported 90 days or less after diagnosis.  A lower proportion of persons aged at least 60 years at diagnosis had baseline sequences reported compared with persons aged 13-19 years (45.1% vs. 50.2%).  Testing rates also differed by race/ethnicity (testing was least common among American Indian/Alaska Native at 45.6%, and most common among Native Hawaiian/Other Pacific Islander at 54.8%); transmission category (53.2% for persons with HIV infection attributable to male-to-male sexual contact and inject drug use, compared to 46.8% for persons with infection attributable to injection drug use); initial CD4 count (62.1% for persons with CD4 cell counts less than 200 cells/µL or opportunistic infections vs. 52.4% for persons with CD4 cell counts at least 500 cells/µL); and geographic region (higher baseline testing was reported in the Midwest at 62.1% compared to 44.2% in the South).  During the time period analyzed, PR/RT with integrase testing increased year to year (from 8.5% to 23.5%) and PR/RT-only testing decreased (from 39.2% to 26.2%).

Author’s Commentary:

Baseline ARV drug resistance testing is recommended at entry into care for all people newly diagnosed with HIV, however findings from this analysis suggest only approximately half of all persons undergo initial PR/RT (with or without integrase) genotype testing in the U.S.  Investigators also observed noteworthy demographic and geographic disparities.  Collectively, these underscore opportunities to improve clinical practice and data reporting systems.  Providers also appear to be including integrase resistance testing alongside PR/RT testing with increasing frequency – although this study is unable to determine reasons for this shift in practice, authors suggest the trend “may reflect the increased use of INSTIs as first-line ART, increased concern about transmitted INSTI resistance, or increased availability and ease of ordering integrase testing in combination with PR/RT testing”.   

The author has no conflicts of interest to disclose.

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