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Reduced Antiretroviral Drug Susceptibility Among Patients With Primary HIV Infection
CONTEXT The transmission of drug-resistant human immunodeficiency virus (HIV) has been documented, but the prevalence of such transmission is unknown. OBJECTIVE To assess the spectrum and frequency of antiretroviral susceptibility among subjects with primary HIV infection. DESIGN, SETTING, AND PATIE...
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Published in: | JAMA : the journal of the American Medical Association 1999-09, Vol.282 (12), p.1142-1149 |
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Main Authors: | , , , , , , , , , , , , , |
Format: | Article |
Language: | English |
Subjects: | |
Citations: | Items that cite this one |
Online Access: | Get full text |
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Summary: | CONTEXT The transmission of drug-resistant human immunodeficiency virus (HIV)
has been documented, but the prevalence of such transmission is unknown. OBJECTIVE To assess the spectrum and frequency of antiretroviral susceptibility
among subjects with primary HIV infection. DESIGN, SETTING, AND PATIENTS Retrospective analysis of 141 subjects identified from clinical research
centers in 5 major metropolitan areas, enrolled from 1989 to 1998, with HIV
seroconversion within the preceding 12 months and no more than 7 days' prior
antiretroviral (ARV) therapy. MAIN OUTCOME MEASURES Phenotypic and genotypic ARV susceptibility of HIV from plasma samples. RESULTS The transmission of drug-resistant HIV as assessed by a greater than
10-fold reduction in ARV susceptibility to 1 or more drugs was observed in
3 (2%) of 141 subjects, including to a nonnucleoside reverse transcriptase
inhibitor in 1 patient and to a nucleoside reverse transcriptase inhibitor
and a protease inhibitor in 2 patients. Population-based sequence analysis
of these 3 samples identified multidrug-resistance mutations in reverse transcriptase
(M184V, T215Y, K219K/R) and protease (L10I/V, K20R, M36I, M46I, G48V, L63P,
A71T, V77I, V82T, I84V, L90M) in the 2 latter patient samples, along with
numerous polymorphisms. A reduction in susceptibility of greater than 2.5-
to 10-fold to 1 or more drugs was observed in viral isolates from 36 patients
(26%). Sequence analysis of these 36 samples identified well-characterized
drug resistance mutation in reverse transcriptase and protease in only 1 of
these patients. CONCLUSIONS Reductions in drug susceptibility of more than 10-fold were rare among
this cohort of recently HIV-infected subjects and were distributed among each
of the 3 major classes of ARV drugs tested. Reductions in susceptibility of
more than 2.5- to 10-fold to certain ARV drugs of unknown clinical significance
were highly prevalent among newly infected patients. Resistance testing may
be warranted to monitor the frequency of drug resistance over time and to
assess the potential for geographic variability. |
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ISSN: | 0098-7484 1538-3598 |
DOI: | 10.1001/jama.282.12.1142 |