Prevalence of transmitted drug resistance associated mutations and HIV-1 subtypes in new HIV-1 diagnoses, U.S.-2006.

OBJECTIVE: To determine the distribution of HIV-1 subtypes and the prevalence of transmitted drug resistance-associated mutations (TDRM) among persons newly diagnosed with HIV-1 infection in the United States. METHODS: We used sequence data from Variant, Atypical, and Resistant HIV Surveillance (VARHS) collected from newly diagnosed persons in 10 states and 1 county health department in 2006. To evaluate TDRM, we used a mutation list for surveillance of TDRM appropriate for the primarily subtype B HIV epidemic in the United States. RESULTS: Sequences were obtained from 2030 of 10,860 persons newly diagnosed with HIV in 11 surveillance areas. Mutations associated with transmitted drug resistance occurred in 292 (14.6%) persons; TDRM associated with a specific drug class occurred in 156 (7.8%) for non-nucleoside reverse transcriptase inhibitors, 111 (5.6%) for nucleoside reverse transcriptase inhibitors and 90 (4.5%) for protease inhibitors. There were no significant differences in prevalence of TDRM by demographic characteristic. The HIV-1 subtype B was the most prevalent subtype occurring in 1922 (96.2%) persons; subtype C (1.3%) was the most prevalent non-B subtype. CONCLUSION: We presented a clade B-optimized mutation list for evaluating surveillance of TDRM in the United States and analyzed the largest collection of sequence data obtained from individuals newly diagnosed with HIV. The prevalence of TDRM in persons newly diagnosed with HIV is higher than in previous U.S. studies; however, this is not necessarily a significant trend. Continued reporting of sequence data for public health purposes from all sources will improve representativeness and accuracy in analyzing trends in transmitted drug resistance and genetic diversity.

Abandonment of infants by HIV-positive women in Russia and prevention measures.

Since 1990, Russia has experienced a dramatic increase in the number of abandoned children, associated with harsh socio-economic conditions, increases in drug and alcohol addiction and HIV infection. Approximately 20% of infants born to HIV-positive mothers are abandoned in Russia. To find out why, we conducted 266 qualitative interviews in 2004-05 in four Russian cities, including HIV-positive women who had abandoned their infants and others who had not, relatives of the women (mostly their mothers), HIV-negative women who had abandoned, and medical experts. Unintended pregnancy was cited as the most important factor influencing the decision to abandon. Other important determinants included lack of partner and family support, drug abuse, fear of birth defects or disabilities, negative attitudes of medical professionals, and marginalized socio-economic status. HIV infection was closely linked to many of these reasons. Important avenues for interventions among HIV-positive women emerged, including improved contraceptive information and provision, education of medical personnel and women on HIV prevention and treatment, enhancement of social support, and strengthening of fostering and adoption programmes for HIV-affected families.