Drug Resistance Patterns, Genetic Subtypes, Clinical Features, and Risk Factors in Military Personnel with HIV-1 Seroconversion

  1. Stephanie K. Brodine, MD;
  2. Richard A. Shaffer, PhD;
  3. Monica J. Starkey, MPH;
  4. Sybil A. Tasker, MD;
  5. Joyce L. Gilcrest, RN;
  6. Mark K. Louder;
  7. Anthony Barile, MD;
  8. Thomas C. VanCott, PhD;
  9. Maryanne T. Vahey, PhD;
  10. Francine E. McCutchan, PhD;
  11. Deborah L. Birx, MD;
  12. Douglas D. Richman, MD; and
  13. John R. Mascola, MD
  1. From Graduate School of Public Health, San Diego State University; Naval Health Research Center; and Naval Medical Center San Diego, San Diego, California; The Henry M. Jackson Foundation for the Advancement of Military Medicine and Walter Reed Army Institute of Research, Rockville, Maryland; and University of California, San Diego, La Jolla, California.

    Abstract

    Background: Regular testing of military personnel identifies early HIV infection; this identification provides a sentinel cohort in which to describe the evolving molecular epidemiology of HIV-1 transmission.

    Objective: To describe the prevalence and epidemiologic correlates associated with the acquisition of non-subtype B and drug-resistant HIV infections.

    Design: Cross-sectional study.

    Setting: Military referral hospital.

    Patients: 95 military personnel with HIV-1 seroconversion.

    Measurements: Self-reported questionnaire, CD4 cell counts, plasma HIV-1 RNA levels, and nucleic acid sequence analysis for drug-resistant mutations and HIV-1 genetic subtype.

    Results: 95 patients were enrolled between February 1997 and February 1998. The likely geographic location of HIV-1 acquisition was overseas in 8% of patients, the United States in 68%, and either overseas or the United States in 24%. Seven patients (7.4%) had subtype E infection; the remainder had subtype B infection. Eight of 31 (26%) treatment-naive patients had mutations in the reverse transcriptase or protease gene associated with drug resistance.

    Conclusions: The percentage of HIV-1 non-subtype B infection and antiretroviral drug-resistant mutations was relatively high in U.S. military personnel with recently acquired HIV-1 infection.

    Article and Author Information

    • Disclaimer: The views expressed in this article are those of the authors and do not reflect the official policy or position of the Department of the Navy, Department of Defense, or the U.S. Government.

    • Acknowledgments: The authors thank the military personnel who contributed to the objectives of this study and whose input will be incorporated into a military-specific HIV/STD prevention program. They also thank Brit Christofferson for technical assistance and database management; Stan Ito for programming and data analyses; Cathy Siwek, Eric Sanders-Buell, and Chris Ettore for laboratory assistance; and Mark Wallace, John McNeil, and Craig Hendrix for manuscript review.

    • Grant Support: In part by Cooperative Agreement DAMD17-93-V 3004 between the U.S. Army Medical Research and Materiel Command, Fort Detrick, Maryland, and the Henry M. Jackson Foundation for the Advancement of Military Medicine, Rockville, Maryland, and Army Reimbursable Work Unit #6816. Dr. Richman was supported by grants AI 27670, AI 38858, AI 36214 (Center for AIDS Research), and grant AI 29164 from the National Institutes of Health. Dr. Richman was also supported by the Research Center for AIDS and HIV Infection of the San Diego Veterans Affairs Medical Center.

    • Requests for Reprints: Stephanie K. Brodine, MD, Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, College of Health and Human Services, 5500 Campanile Drive, San Diego, CA 92182-4162. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints{at}mail.acponline.org.

    • Current Author Addresses: Dr. Brodine: Epidemiology and Biostatistics, Graduate School of Public Health, San Diego State University, College of Health and Human Services, 5500 Campanile Drive, San Diego, CA 92182-4162.

    • Dr. Shaffer: Naval Health Research Center, Division of Clinical Epidemiology, Box 85122, San Diego, CA 92186.

    • Ms. Starkey: Naval Health Research Center, 271 Catalina Boulevard, Building 304, San Diego, CA 92152.

    • Dr. Tasker and Ms. Gilcrest: Naval Medical Center San Diego, Infectious Diseases, 34800 Bob Wilson Drive, Box 575, San Diego, CA 92134-5000.

    • Mr. Louder: Henry M. Jackson Foundation, 13 Taft Court, Suite 200, Rockville, MD 20850.

    • Dr. Barile: HIV Clinical Research Program, National Naval Medical Center, 8901 Wisconsin Avenue, Special Immunology Clinic, Bethesda, MD 20889.

    • Dr. VanCott: Henry M. Jackson Foundation, 13 Taft Court, Suite 200, Rockville, MD 20850.

    • Dr. Vahey: Division of Retrovirology, Walter Reed Army Institute of Research, 1600 East Gude Drive, Rockville, MD 20850.

    • Dr. McCutchan: Henry M. Jackson Foundation, Global Molecular Epidemiology Program, 1 Taft Court, Suite 250, Rockville, MD 20850.

    • Dr. Birx: Division of Retrovirology, Walter Reed Army Institute of Research, 13 Taft Court, Suite 200, Rockville, MD 20850.

    • Dr. Richman: San Diego Veterans Affairs Medical Center, 3350 La Jolla Village Drive, San Diego, CA 92161.

    • Dr. Mascola: Division of Retrovirology, Walter Reed Army Institute of Research, 1 Taft Court, Suite 250, Rockville, MD 20850.

    Summary for Patients

    • Summaries for Patients:Features of the Human Immunodeficiency Virus (HIV) in Military Personnel with Recent Infection Ann Intern Med October 5, 1999 131:502
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    1. Ann Intern Med October 5, 1999 vol. 131 no. 7 502-506
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