[Genotypic resistance in HIV-1-infected patients with persistent low-level viremia]

Enferm Infecc Microbiol Clin. 2009 Feb;27(2):75-80. doi: 10.1016/j.eimc.2008.02.007. Epub 2009 Feb 13.
[Article in Spanish]

Abstract

Introduction: Highly active antiretroviral therapy (HAART) in HIV patients is considered successful when plasma viral load (VL) reaches < 50 copies/ml. However, many patients have a persistent VL of 50 to 1000 copies/ml, and treatment guidelines do not recommend genotypic resistance testing at these levels because of poor performance. The aim of this study was to evaluate the usefulness of a concentration technique for HIV-1 sequencing in samples with < 1000 copies/ml, and determine the virological consequences of HAART treatment changes guided by resistance testing in this scenario.

Methods: Observational study performed in 51 patients with plasma VL between 50 and 1000 copies/m; 27 patients had these levels for at least 12 consecutive months. Prior to RNA extraction, virions were concentrated from 3-ml plasma samples and then genotyped following standard procedures.

Results: Forty-seven of the 51 samples were successfully sequenced, resulting in a sensitivity of 92%. Among these 47 patients, 27 showed a persistent viral load of 50-1000 copies/ml for 12 months, and 20 patients achieved undetectable viral load following the genotype-guided HAART change (intention-to-treat analysis: NC = F; 20 of 27 [74.1%]; on-treatment analysis: 20 of 23 [86.9%]).

Conclusions: We report a simple method for genotype sequencing in patients with persistent low-level viremia that allowed a modification of the HAART regimen leading to undetectable plasma viremia.

Publication types

  • English Abstract
  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Anti-HIV Agents / pharmacology*
  • Anti-HIV Agents / therapeutic use
  • Antiretroviral Therapy, Highly Active
  • Drug Resistance, Multiple, Viral / genetics*
  • HIV Infections / blood
  • HIV Infections / drug therapy*
  • HIV Protease / genetics*
  • HIV Reverse Transcriptase / genetics*
  • HIV-1 / drug effects
  • HIV-1 / enzymology
  • HIV-1 / genetics*
  • HIV-1 / isolation & purification
  • Humans
  • RNA, Viral / genetics*
  • RNA, Viral / isolation & purification
  • Selection, Genetic
  • Sequence Analysis, RNA / methods
  • Viral Load
  • Viremia / drug therapy*
  • Viremia / microbiology

Substances

  • Anti-HIV Agents
  • RNA, Viral
  • reverse transcriptase, Human immunodeficiency virus 1
  • HIV Reverse Transcriptase
  • HIV Protease
  • p16 protease, Human immunodeficiency virus 1