Virus mutations that confer resistance against certain antiretrovirals are more common in Florida counties with lower socioeconomic status, higher unemployment rates, and poor mental health compared to other counties in the state, a retrospective analysis of 34,447 HIV sequences published in The Journal of Infectious Diseases found.
The samples were obtained between 2012 and 2017 and sequenced for mutations known to be associated with resistance to HIV drugs. Overall, resistance was more prevalent in Florida—the state with the highest HIV incidence in the U.S.—than in North America in general. The prevalence of any drug class mutation was highest for NNRTIs (30%), followed by 19% for NRTIs, 8% for integrase inhibitors, and 7% for protease inhibitors. (The researchers did not explore the effect of drug resistance on treatment efficacy or virologic failure.)
The authors found significant heterogeneity among demographic subgroups. For instance, multi-drug resistance and NRTI resistance were slightly higher among men than women; Black people had higher rates of resistance to integrase inhibitors, NRTIs, and NNRTIs than white people, but a lower rate of resistance to protease inhibitors than white or Latinx people; and NNRTI resistance rates in particular appeared to vary widely by county.
People who acquired HIV perinatally had the highest odds of drug resistance, likely due to transmitted mutations from the mother. Surprisingly, people who inject drugs had lower odds; study authors credited this result to the state’s test-and-treat initiative, but called for additional analysis of the finding.
While overall resistance against protease and integrase inhibitors was lower than other drug classes, it was more common in samples from later years, indicating an increase in such mutations—although the study authors acknowledged that shifting prescribing practices could be a confounding factor that was not accounted for in the study.
Despite the study findings, the authors warned against using county-level socioeconomic data to form assumptions regarding a specific individual’s level of drug resistance. They called for more genotype testing of individuals’ virus as well as molecular surveillance to support public health in the state.