Pretreatment integrase strand transfer inhibitor resistance in North Carolina from 2010-2016

AIDS. 2017 Oct 23;31(16):2235-2244. doi: 10.1097/QAD.0000000000001611.


Objective: We sought to define the prevalence of pretreatment integrase strand transfer inhibitor (INSTI) resistance and assess the transmission networks of those with pretreatment INSTI resistance.

Design: A retrospective cohort study of HIV-positive patients with genotypic resistance testing sent to a single referral laboratory in North Carolina between 2010 and 2016.

Methods: We linked genotype and public health data for in-care HIV-positive individuals to determine the prevalence of INSTI resistance among treatment-naive (defined as those with a first genotype ≤3 months after diagnosis) and treatment-experienced (defined as those with a first genotype >3 months after diagnosis) patients. We performed molecular and phylogenetic analyses to assess whether pretreatment INSTI resistance mutations represented clustered HIV transmission.

Results: Of 8825 individuals who contributed sequences for protease, reverse transcriptase, or INSTI genotypic resistance testing during the study period, 2784 (31%) contributed at least one sequence for INSTI resistance testing. Of these, 840 were treatment-naive individuals and 20 [2.4%, 95% confidence interval (CI): 1.5, 3.6%] had INSTI mutations; only two (0.2%, 95% CI: 0.02, 0.9%) had major mutations. Of 1944 treatment-experienced individuals, 9.6% (95% CI: 8.3, 11.0%) had any INSTI mutation and 7.0% (95% CI: 5.9, 8.3%) had major mutations; the prevalence of INSTI mutations among treatment-experienced patients decreased overtime (P < 0.001). In total 12 of 20 individuals with pretreatment INSTI mutations were part of 10 molecular transmission clusters; only one cluster shared identical minor mutations.

Conclusion: The prevalence of major pretreatment INSTI resistance is very low. Pretreatment INSTI mutations do not appear to represent clustered HIV transmission.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Disease Transmission, Infectious
  • Drug Resistance, Viral*
  • Female
  • Genotype
  • Genotyping Techniques
  • HIV / classification
  • HIV / drug effects*
  • HIV / genetics
  • HIV / isolation & purification
  • HIV Infections / transmission
  • HIV Infections / virology*
  • HIV Integrase Inhibitors / pharmacology*
  • Humans
  • Male
  • Middle Aged
  • North Carolina
  • Phylogeny
  • Prevalence
  • Retrospective Studies
  • Young Adult


  • HIV Integrase Inhibitors