- Chen, Iris;
- Connor, Matthew B;
- Clarke, William;
- Marzinke, Mark A;
- Cummings, Vanessa;
- Breaud, Autumn;
- Fogel, Jessica M;
- Laeyendecker, Oliver;
- Fields, Sheldon D;
- Donnell, Deborah;
- Griffith, Sam;
- Scott, Hyman M;
- Shoptaw, Steven;
- del Rio, Carlos;
- Magnus, Manya;
- Mannheimer, Sharon;
- Wheeler, Darrell P;
- Mayer, Kenneth H;
- Koblin, Beryl A;
- Eshleman, Susan H
Background
HIV Prevention Trials Network (HPTN) 061 enrolled black men who have sex with men in the United States. Some men with low/undetectable HIV RNA had unusual patterns of antiretroviral (ARV) drug use or had drugs detected in the absence of viral suppression. This report includes a comprehensive analysis of ARV drug use and drug resistance among men in HPTN 061 who were not virally suppressed.Methods
The analysis included 169 men who had viral loads >400 copies per milliliter at enrollment, including 3 with acute infection and 13 with recent infection. By self-report, 88 were previously diagnosed, including 31 in care; 137 men reported no ARV drug use. Samples from these 169 men and 23 seroconverters were analyzed with HIV genotyping and ARV drug assays.Results
Forty-eight (28%) of the 169 men had ≥ 1 drug resistance mutation (DRM); 19 (11%) had multiclass resistance. Sixty men (36%) had ≥ 1 ARV drug detected, 42 (70%) of whom reported no ARV drug use. Nine (23%) of 39 newly infected men had ≥ 1 DRM; 10 had ≥ 1 ARV drug detected. Unusual patterns of ARV drugs were detected more frequently in newly diagnosed men than previously diagnosed men. The rate of transmitted drug resistance was 23% based on HIV genotyping and self-reported ARV drug use but was 12% after adjusting for ARV drug detection.Conclusions
Many men in HPTN 061 had drug-resistant HIV, and many were at risk of acquiring additional DRMs. ARV drug testing revealed unusual patterns of ARV drug use and provided a more accurate estimate of transmitted drug resistance.