Sociodemographic, ecological, and spatiotemporal factors associated with HIV drug resistance in Florida: a retrospective analysis.

BACKGROUND: Persons living with HIV (PWH) with resistance to antiretroviral therapy (ART) are vulnerable to adverse HIV-related health outcomes and can contribute to transmission of HIV drug resistance (HIVDR) when non-virally suppressed. The degree to which HIVDR contributes to disease burden in Florida -the US state with the highest HIV incidence- is unknown.

METHODS: We explored sociodemographic, ecological, and spatial-temporal associations of HIVDR. HIV-1 sequences (n=34,447) collected during 2012-2017 were obtained from the Florida Department of Health. HIVDR was categorized by ART class: nucleoside reverse transcriptase inhibitors (NRTI), non-NRTI (NNRTI), protease inhibitors (PI), and integrase inhibitors (INSTI). Multi-drug resistance (MDR) and transmitted-drug resistance (TDR) were also evaluated. Multivariable fixed-effects logistic regression models were fitted to associate individual and county-level sociodemographic and ecological health indicators with HIVDR.

RESULTS: HIVDR prevalence was 19.2% (NRTI), 29.7% (NNRTI), 6.6% (PI), 23.5% (TDR), 13.2% (MDR), and 8.2% (INSTI) with significant variation by Florida county. Individuals who were older, Black, or acquired HIV through mother-to-child transmission had significantly higher odds of HIVDR. HIVDR was linked to counties with lower socioeconomic status, higher unemployment, and poor mental health.

CONCLUSIONS: Our findings indicate HIVDR prevalence is higher in Florida than aggregate North American estimates with significant geographic and socioecological heterogeneity.