Prevalencia de resistencia primaria en pacientes con infección reciente por VIH-1 en Chile / Prevalence of primary antiretroviral resistance among HIV infected patients in Chile

Background: The main cause of virological failure during AIDS treatment is the resistance to antiretroviral medications (ARV). Aim: To search for mutations associated with ARV resistance in recently HIV-1 infected patients naïve to treatment, in Chile. Material and Methods: Patients over 18 years old with HIV-1 infection, naïve to antiretroviral drugs before the study were included. Patients with CD4 cell counts less than 200 cells/mm³, viral load below 2.000 copies/mL or any condition indicative of advanced AIDS were excluded. Criteria for diagnosis of recent infection (< 18 months) were a previous negative test for HIV antibodies or a history of an acute retroviral syndrome in the past 18 months. Resistance to drugs was analyzed using the TRUGENEtm HIV-1 assay from Bayer and the OpenGene DNA sequencing system. Results: Ninety nine percent of patients had at least one mutation, 27 percent had 4 or more mutations, but high level resistance to ARV was found only in 2.7 percent of cases. Point mutations for non nucleoside reverse transcriptase inhibitors (NNRTI) were detected in 4.1 percent of cases (K103N in 1 patient, V179D in 2 patients), for nucleoside reverse transcriptase inhibitors (NRTI) in 8.1 percent of cases (T215S in 1 patient, V118I in 4 patients, M41L in 1 patient) and for protease inhibitors (PI) in 1.3 percent of cases. All mutations detected in the protease gene were secondary. Of these, the most common were L63P/T (38 patients), L10I/V (27 patients) and V77I (26 patients). Resistance to two or more antiretroviral classes was not detected. Conclusions: This study supports that, by now, primary resistance has a low prevalence in Chile. Therefore, a genotyping test before starting antiretroviral therapy is not necessary.

Manifestaciones reumatológicas en pacientes con síndrome de inmunodeficiencia adquirida (VIH/SIDA) / Rheumatic manifestations in patient with human immunodeficiency virus infection

HIV infection produces a state of alteration in the immune system that not only increases the susceptibility to infections and tumors, but also leads to autoimmune conditions such as those found in rheumatology. These patients manifest a greater frequency of polyarthritis, pelvic spondylopathy, Sjõgren’s syndrome, myopias, and certain vasculitis. On the other hand, there is a great harboring and overexposure of symptoms among systemic autoimmune diseases (e.g. systemic lupus erythematosus, vasculitis), as well as HIV itself, which together with a greater frequency of autoantibodies in these patients, can frequently make differential diagnosis quite difficult. It is important to know about the existence of exclusive autoimmune manifestations, such as the diffuse infiltrative lymphocytosis syndrome, characterized by parotid hypertrophy, intestinal pneumonia and myopathy. However, new rheumatic conditions have appeared with the use of the highly successful antiretroviral therapy, whether caused by adverse reactions to drugs (myopathies, arthritis,neuropathologies) or within the context of the immune reconstitution syndrome, in which reactions such as sarcoidosis, the appearance or exacerbation of a preexisting rheumatoid arthritis and Graves disease, among others, have been described. Knowing the interrelation between autoimmune pathologies and HIV is important for the adequate diagnosis of both types of conditions and may provide information as to immunopathogenicity of both diseases.