Use of HIV Resistance Testing After Prolonged Treatment Interruption

被引:6
作者
Iarikov, Dmitri E. [1 ]
Irizarry-Acosta, Melina [2 ]
Martorell, Claudia [4 ]
Rauch, Carol A. [3 ]
Hoffman, Robert P. [5 ]
Skiest, Daniel J. [1 ]
机构
[1] Tufts Univ, Sch Med, Div Infect Dis, Springfield, MA 01199 USA
[2] Tufts Univ, Sch Med, Dept Med, Springfield, MA 01199 USA
[3] Tufts Univ, Sch Med, Dept Pathol, Baystate Med Ctr, Springfield, MA 01199 USA
[4] Res Inst, Springfield, MA USA
[5] Mercy Med Ctr, Springfield, MA USA
关键词
HIV-1 genotypic resistance testing; resistance testing in treatment-experienced patients; persistence of resistance mutations; HUMAN-IMMUNODEFICIENCY-VIRUS; ANTIRETROVIRAL COMBINATION THERAPY; REVERSE-TRANSCRIPTASE INHIBITORS; DRUG-RESISTANCE; IMMUNOLOGICAL CONSEQUENCES; PROTEASE INHIBITORS; PERSISTENCE; MUTATIONS; INFECTION; ADULTS;
D O I
10.1097/QAI.0b013e3181c79ab0
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background: HIV-1 genotypic resistance testing is not routinely recommended for patients who have been off antiretroviral therapy (ART) for longer than 4 weeks. We assessed the results and use of resistance testing in patients off ART. Methods: All HIV resistance genotypes from November 2003 through April 2008 were reviewed from one large teaching hospital and two private HIV practices. Inclusion criterion was having a genotypic resistance test after an ART interruption of at least 2 months. Medical records were reviewed using a standardized data collection sheet. Results: Sixty-two of 304 treatment-experienced patients with HIV genotypes met the inclusion criteria. Prior cumulative ART class exposure included nucleoside reverse transcriptase inhibitors in 54 patients, nonnucleoside reverse transcriptase inhibitors in 32 patients, and protease inhibitors in 30 patients. Resistance testing was performed at a mean of 12 months (range, 2.5-48 months) after ART interruption. The mean time between ART interruption and resistance testing did not differ for patients with mutations and those without mutations detected. Seventeen of 62 (27.4%) patients were found to have resistance mutations. Eleven patients were found to have mutations to nonnucleoside reverse transcriptase inhibitors, four patients had mutations to nucleoside reverse transcriptase inhibitors, and two patients had protease inhibitor-associated mutations. No patient had multiclass resistance. Among the 17 patients with mutations after treatment interruption, 15 had mutations that were either not present on a prior genotype (n = 2) or did not have a prior genotype (n = 13). Conclusions: HIV genotypic resistance assays may identify mutations even when performed after a prolonged treatment interruption and may offer clinically significant information. Current guidelines that discourage resistance testing after treatment interruptions of longer than 4 weeks should be re-evaluated.
引用
收藏
页码:333 / 337
页数:5
相关论文
共 23 条
[1]   PERSISTENCE OF AZIDOTHYMIDINE-RESISTANT HUMAN-IMMUNODEFICIENCY-VIRUS TYPE-1 RNA GENOTYPES IN POSTTREATMENT SERA [J].
ALBERT, J ;
WAHLBERG, J ;
LUNDEBERG, J ;
COX, S ;
SANDSTROM, E ;
WAHREN, B ;
UHLEN, M .
JOURNAL OF VIROLOGY, 1992, 66 (09) :5627-5630
[2]  
[Anonymous], 2008, DEP HLTH HUMAN SERVI, P1
[3]   Persistence of primary drug resistance among recently HIV-1 infected adults [J].
Barbour, JD ;
Hecht, FA ;
Wrin, T ;
Liegler, TJ ;
Ramstead, CA ;
Busch, MP ;
Segal, MR ;
Petropoulos, CJ ;
Grant, RM .
AIDS, 2004, 18 (12) :1683-1689
[4]   An updated systematic overview of triple combination therapy in antiretroviral-naive HIV-infected adults [J].
Bartlett, John A. ;
Fath, Michael J. ;
DeMasi, Ralph ;
Hermes, Ashwaq ;
Quinn, Joseph ;
Mondou, Elsa ;
Rousseau, Franck .
AIDS, 2006, 20 (16) :2051-2064
[5]   Kinetics of HIV-1 RNA and resistance-associated mutations after cessation of antiretroviral combination therapy [J].
Birk, M ;
Svedhem, V ;
Sönnerborg, A .
AIDS, 2001, 15 (11) :1359-1368
[6]   Determinants of HIV drug resistance mutations in plasma virus after treatment interruption [J].
Chilton, D ;
Dervisevic, S ;
Pillay, D ;
Rider, A ;
Copas, A ;
Miller, RF ;
Edwards, SG .
AIDS, 2005, 19 (18) :2174-2175
[7]   Virologic and immunologic consequences of discontinuing combination antiretroviral-drug therapy in HIV-infected patients with detectable viremia. [J].
Deeks, SG ;
Wrin, T ;
Liegler, T ;
Hoh, R ;
Hayden, M ;
Barbour, JD ;
Hellmann, NS ;
Petropoulos, CJ ;
McCune, JM ;
Hellerstein, MK ;
Grant, RM .
NEW ENGLAND JOURNAL OF MEDICINE, 2001, 344 (07) :472-480
[8]   Interruption of treatment with individual therapeutic drug classes in adults with multidrug-resistant HIV-1 infection [J].
Deeks, SG ;
Hoh, R ;
Neilands, TB ;
Liegler, T ;
Aweeka, F ;
Petropoulos, CJ ;
Grant, RM ;
Martin, JN .
JOURNAL OF INFECTIOUS DISEASES, 2005, 192 (09) :1537-1544
[9]  
Devereux HL, 1999, AIDS, V13, pF123, DOI 10.1097/00002030-199912240-00001
[10]   Sensitive drug-resistance assays reveal long-term persistence of HIV-1 variants with the K103N Nevirapine (NVP) resistance mutation in some women and infants after the administration of single-dose NVP: HIVNET 012 [J].
Flys, T ;
Nissley, DV ;
Claasen, CW ;
Jones, D ;
Shi, CJ ;
Guay, LA ;
Musoke, P ;
Mmiro, F ;
Strathern, JN ;
Jackson, JB ;
Eshleman, JR ;
Eshleman, SH .
JOURNAL OF INFECTIOUS DISEASES, 2005, 192 (01) :24-29