Completeness of HIV nucleotide sequence ascertainment and its potential impact on understanding HIV transmission – Maryland, 2011–2013^*

* The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

ABSTRACT

HIV nucleotide sequences generated through routine drug resistance testing (DRT) and reported to Maryland's Molecular HIV Surveillance system are most effective for elucidating transmission patterns and identifying outbreaks if DRT is ordered promptly and sequences are reported completely. Among reported cases of HIV infection newly diagnosed during 2011–2013 in Maryland residents aged ≥13 years, we assessed sequence ascertainment completeness. To better understand which populations were most likely to have a sequence, we examined associations between sequence ascertainment and clinical and demographic characteristics. During 2011–2013, 4423 new HIV infection diagnoses were reported; sequences were ascertained for 1282 (29.0%). Among 3267 cases with complete data, odds for having a sequence ascertained were highest for cases in persons living inside Maryland's Central Region with initial CD4 counts ≤500 cells/mm³ (adjusted odds ratio [aOR] 2.4, 95% confidence interval [CI] 1.9–3.1). Sequence ascertainment did not vary significantly by patient age, sex, race/ethnicity or HIV transmission category. Educational interventions, policy changes and improved processes to increase timely DRT and subsequent sequence reporting with a focus on testing at entry to care, particularly for those with higher CD4 counts and those living outside the Central Region, might improve ascertainment completeness.

KEYWORDS:

• HIV
• drug resistance testing
• surveillance
• molecular epidemiology

Acknowledgments

The authors gratefully acknowledge the valuable contributions of the following persons to this manuscript: Andrea Winquist, Harold Boykin, Jami Stockdale, Molly Gribbin, Lucy Wilson, and Alexa Oster.

Disclosure statement

No potential conflict of interest was reported by the authors.

Notes

* The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.