Abstract
Background
HIV-1 transmitted drug resistance (TDR) remains a global challenge that can impact care, yet its comprehensive assessment is limited and heterogenous. We longitudinally characterized statewide TDR in Rhode Island.
Methods
Demographic and clinical data from treatment-naïve individuals were linked to protease, reverse transcriptase and integrase sequences, routinely obtained over 2004–2020. TDR extent, trends, impact on 1 st-line regimens, and association with transmission networks were assessed using Stanford Database, Mann-Kendall statistic, and phylogenetic tools.
Results
In 1,123 individuals, TDR to any antiretroviral increased from 8% (2004) to 26% (2020), driven by NNRTI (5-18%), and less NRTI TDR (2-8%). Dual- and triple-class TDR were low and major InSTI resistance was absent. Predicted intermediate-high resistance was in 77% of those with TDR, with differential suppression patterns. Among all individuals, 34% were in molecular clusters, some only with members with TDR who shared mutations. Among clustered individuals, people with TDR were more likely in small clusters.
Conclusions
In a unique (statewide) assessment over 2004–2020, TDR increased, primarily, but not solely, driven by NNRTIs, impacting antiretroviral regimens. Limited TDR to multi-class regimens and PrEP are encouraging, however, surveillance and its integration with molecular epidemiology should continue, to potentially improve care and prevention interventions.