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HIV INTEGRASE GENOTYPIC TESTING AND RESISTANCE IN THE UNITED STATES—9 JURISDICTIONS
Angela L. Hernandez1, M. Cheryl B. Ocfemia1, Neeraja Saduvala2, Alexandra Oster1, Walid Heneine1, Jeffrey A. Johnson1, Irene Hall1
1CDC, Atlanta, GA, USA,2ICF Intl, Atlanta, GA, USA
In 2016, national drug resistance testing guidelines were updated to recommend providers include integrase (IN) genotypic testing at entry into HIV care if transmitted resistance to integrase strand transfer inhibitors (INSTI) is a concern. We used National HIV Surveillance System (NHSS) data to assess the prevalence of IN genotypic testing and INSTI-associated resistance.
We analyzed HIV-1 sequences from persons with HIV infection diagnosed through 2014 and reported to NHSS by December 2015 from 9 surveillance jurisdictions (Colorado, Connecticut, California [Los Angeles County], Michigan, New York, Philadelphia, South Carolina, Texas, and Washington). We describe (1) overall prevalence and timing of IN genotypic tests after HIV diagnosis (≤3 months and >3 months) by sex, age, race/ethnicity, transmission category, stage of HIV disease, population of area of residence at diagnosis, and antiretroviral use (ARV) at diagnosis, and (2) prevalence of INSTI-resistant associated mutations using the updated CDC HIV-1 surveillance mutation list.
We analyzed 14,468 IN sequences; 7,107 (49%) sequences were IN only. IN genotypic testing was more common among males, persons aged 20-29 years, blacks; by transmission category, more common among males with HIV infection attributed to male-to-male sexual contact, heterosexual females, persons who were not stage 3 of HIV disease (AIDS), and persons residing in areas with a population of >500,000. Prevalence of INSTI-resistant mutations among all IN sequences was extremely low (65/14,468; 0.4%). Of these, the most prevalent mutations were N155H (38%), followed by E92Q (29%) and G140S (25%). IN genotypic testing was performed ≤3 months after diagnosis for 5,240 (36%) persons, of which 4,631 (88%) had no evidence of ARV use; 2 (0.04%) had transmitted INSTI-associated resistance (N155H [100%]; E92Q [50%]).
INSTI-resistant mutations are rare and indicate that current INSTI-based regimens remain effective. A majority of genotypic testing for resistance to INSTIs occurs more than 3 months of HIV diagnosis likely after initiation of antiretroviral therapy. NHSS provides the opportunity to monitor IN genotypic testing and prevalence of INSTI-associated resistance at a population level.