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Transmitted drug resistance (TDR) — a well-described phenomenon in areas where access to antiretroviral therapy (ART) is established — is being seen with increasing frequency in many settings with more-recent ART introduction. Often, the most common transmitted resistance mutation is K103N, which confers resistance to first-generation nonnucleoside reverse transcriptase inhibitors (efavirenz, nevirapine).
After noticing an increased frequency of the K103N mutation among patients with newly diagnosed HIV infection in Belgium, investigators used phylogenetic analysis of HIV viral sequences to identify a transmission cluster of 29 persons, 22 of whom were infected with virus carrying this mutation. Linkage of phylogenetic information with epide…