RESUMO
The prevalence of human immunodeficiency virus (HIV) type 1 antiretroviral resistance is expected to be higher in recently infected antiretroviral-naive individuals than in those who have been infected longer. Antiretroviral-naive HIV-1-infected adults who presented to an outpatient clinic in an urban hospital in Boston for initial evaluation in 1999 were screened for drug-selected resistance mutations and phylogenetic subtype. Drug-selected mutations were identified in 16 (18%) of 88 subjects. Twelve (14%) included mutations associated with nucleoside reverse-transcriptase inhibitors, 4 (5%) included mutations associated with nonnucleoside reverse-transcriptase inhibitors, and 3 (3%) included mutations associated with protease inhibitors. Two (2%) had resistance mutations associated with multiple classes of drugs. Nine (10%) subjects had infection with non-B subtype HIV-1 and did not have drug-selected mutations. Serological results indicated infection for >/=6 months. Drug-selected mutations or non-B subtypes were detected in a substantial portion of antiretroviral-naive adults who had been infected for at least 6 months.
Assuntos
Farmacorresistência Viral/genética , Infecções por HIV/virologia , HIV-1/genética , Adulto , Fármacos Anti-HIV/efeitos adversos , Fármacos Anti-HIV/uso terapêutico , Sequência de Bases , Boston , Infecções por HIV/tratamento farmacológico , Protease de HIV/química , Protease de HIV/genética , Transcriptase Reversa do HIV/química , Transcriptase Reversa do HIV/genética , HIV-1/classificação , Humanos , Dados de Sequência Molecular , Filogenia , Mutação Puntual/genética , RNA Viral/sangue , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Seleção Genética , Análise de Sequência de DNA , Carga ViralRESUMO
BACKGROUND: Despite current recommendations for human immunodeficiency virus (HIV) counseling and testing among patients admitted to hospitals with at least a 1% prevalence of HIV infection, an estimated 300 000 people in the United States remain unaware of their HIV infection. METHODS: We implemented the Think HIV program, which offered voluntary HIV counseling and testing to patients admitted to the medical service of a Boston, Mass, teaching hospital. We compared the results of this effort with testing results from a 15-month historical control period. RESULTS: Patients admitted during the program period were 3.4 times more likely to undergo testing for HIV than those admitted during the control period (95% confidence interval [CI], 2.8-4.1). The testing program detected approximately 2 new diagnoses of HIV infection per month, compared with 1 per month during the control period. Patients who underwent testing during the program, and who likely would not have done so without this initiative, had an estimated prevalence of HIV infection of 3.8% (95% CI, 1.8%-5.8%). CONCLUSIONS: Testing efforts for HIV targeted to only symptomatic patients are inadequate to identify the one third of HIV-seropositive people in the United States who are unaware of their infection. We have shown that in a single urban hospital, offering voluntary, routine inpatient HIV counseling and testing can be successful as a screening program by identifying a substantial number of patients with undiagnosed HIV. These patients then can be informed, counseled, and linked to care and treatment. Seventy-two hospitals nationwide have demographics similar to those of the study hospital, suggesting that these results are generalizable to many urban hospitals.
