OBJECTIVES: Genetic mutations in HIV can confer resistance to antiretroviral therapies (ART), known as HIV drug resistance (HIVDR). This study assessed management of HIVDR in the United States over time. While previous reports have focused on mutations that confer drug resistance to any ART class, this is the first study to report prevalence of medication switching due to HIVDR.

METHODS: Using ICD-10 and Current Procedural Terminology codes, de-identified patient records from a U.S. electronic health record database were used to determine clinical characteristics and prevalence of HIVDR between January 2012 and November 2022. Cases of transmitted HIVDR were determined as initiation of ART within one year of a positive HIVDR panel. Acquired HIVDR (due to spurious mutations) was determined as a switch in ART regimen in conjunction with an HIVDR panel performed within one year of the medication switch. Prevalence was determined as the number of annual transmitted/acquired HIVDR cases divided by the annual number receiving ART.

RESULTS: Males comprised 72.6% of HIVDR cases. Black individuals comprised the largest proportion (44.6%) followed by white (18.3%), Asian/Pacific Islanders (0.9%), and Hispanics (0.7%). From 2012 to 2022, annual prevalence of transmitted HIVDR decreased from 1.6% to 0.8%, and annual prevalence of acquired HIVDR decreased from 0.8% to 0.4%. Most patients with acquired HIVDR received new medication 0-30 days after an HIVDR panel (66.4%); however, 12.6% of patients did not initiate new ART regimens until >181 days after.

CONCLUSIONS: These findings demonstrate that HIV management efforts in the U.S. have resulted in clear progress in treating people living with HIVDR; however, HIVDR affects specific populations to a greater extent than others, highlighting the immediate need for continued efforts in developing targeted HIVDR management. Notably, the low prevalence of Hispanics may be due to sampling bias within the database.