BACKGROUND: HIV genetic sequence analyses, which are generated through routine HIV drug-resistance testing and reported by laboratories to Maryland’s Molecular HIV Surveillance system, can elucidate transmission patterns and identify outbreaks, but only if sequences are ordered promptly and results are reported completely. Guidelines recommend ordering sequences when patients enter care, rather than waiting for advanced disease with lower CD4 counts. We assessed HIV sequence ascertainment completeness among HIV-infected Maryland residents.
METHODS: Among Maryland residents with new HIV diagnoses during 2011–2013, we calculated percentage with sequences ascertained by February 2015. We calculated chi-square P-values and risk ratios (RRs) to compare percentages by demographic, risk, and clinical characteristics.
RESULTS: During 2011–2013, a total of 4,436 Maryland residents received new HIV infection diagnoses; sequences were available for 1,285 (29.0%). Median time from diagnosis to sequence report was 28.5 days (interquartile range: 8–175). Among 926 persons aged ≥50 years, 25.1% had a sequence, compared with 30.0% of 3,510 persons aged <50 years (RR: 0.8; P = .003). Among 1,925 residents of counties comprising Maryland’s National Capital Region (NCR), 23.8% had a sequence, compared with 32.9% of 2,511 residents of other regions (RR: 0.7; P <.0001). Among 2,543 persons with an initial CD4 count <500, approximately 35.5% had a sequence, compared with 20.2% of 1,893 persons with higher CD4 counts (RR: 1.8; P <.0001). Sequence reporting did not vary substantially by race/ethnicity or transmission risk category.
CONCLUSIONS: Sequence ascertainment in Maryland is low. Ensuring complete reporting from testing laboratories and educating providers concerning genotype testing importance at entry to care, with particular attention to NCR, older patients, and those with higher CD4 counts, might improve reporting completeness.