Transmitted drug resistance mutations (TDRM) have been a constant threat to treatment efficacy. We evaluated TDRM in plasma RNA of 217 antiretroviral therapy-naive patients from sites in the São Paulo metropolitan area, collected from 2012 to 2014. The partial HIV-1 polymerase region was sequenced using Big Dye terminators at an ABI 3130 Genetic Analyzer. TDRM was defined according to the Stanford database calibrated population resistance (CPR v.6.0), but other drug resistance mutations (DRM) considered at the IAS list (IAS, 2014) and at the Stanford HIV Database Genotyping Resistance Interpretation (GRI-HIVdb) were also described. Out of 78% (170/217) of patients with information on the time of diagnosis, most (83%, 141/170) had been recently diagnosed, with the first positive HIV serology at a median of 58 days (IQR 18-184). Subtype B predominated (70%), followed by subtype F (10%), BF (7.5%), C (7.5%), and BC (5%). TDRMs were observed in 9.2% (20/217, CI 95% 5.9% to 13.6%), mostly (5.2%) to nonnucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral class. Among children and adolescents, only a single patient showed TDRMs. Additional non-CPR mutations were observed: 11.5% (25/217) according to IAS or 4.6% (10/217) according to GRI-HIVdb. Overall, 23.5% (51/217) of the cases had one or more DRM identified. TDRM prevalence differed significantly among some sites. These trends deserve continuous and systematic surveillance, especially with the new policies of treatment as prevention being implemented in the country.

Background: Antiretroviral therapy (ART) is free in Brazil and indicated for all people living with HIV since December 2013 regardless of CD4 T cell count. The benefits of rapid ART include less risk of AIDS and non-AIDS conditions to the individual as well as lower transmissibility (Undetectable = Untransmittable). However, ART introduction may take months after diagnosis as an immediate treatment it is not a priority in many places. Method: We evaluated the time to loss of follow-up (LTFU) of 589 patients diagnosed in up to 6 months, stratified according to the time between diagnosis and ART initiation, as same week (SW), for those starting ART within 7 days of diagnosis, intermediate (I) between 8 and 30 days and late treatment (LT), for those treated after 31 days. Patients without ART withdrawal in the last 100 days were considered LTFU. Analysis was performed using the Cox proportional-hazards model. Results: The 589 consecutive patients admitted were stratified as SW 18% (n = 105), intermediate 20% (n = 119) and LT 62% (n = 365). The LTFU outcome was not different among strata (hazard ratio 1.02, 95%CI 0.71-1.46). However, LTFU was higher among non-Whites (hazard ratio 1.85, 95%CI 1.07-3.20) and transwomen (hazard ratio 2.97, 95%CI 1.35-6.55). Cox regression analyses adjusted for strata were associated for transwomen to stratum SW (hazard ratio 6.90, 95%CI 1.64-28.97) and for non-Whites to stratum LT (hazard ratio 2.34, 95%CI 1. 30-4.22). Conclusion:Our study suggests that the rapid antiretroviral treatment is feasible in public units, without increases in LTFU for cases treated in the same week. However, special attention should be given to transwomen and non-Whites with public policies aimed at reducing racial and gender inequalities.