ABSTRACT
BACKGROUND: This study examines the prevalence of primary resistance to antiretroviral drugs in patients diagnosed with HIV infection during 2002 to 2005 and determines the clinical and epidemiological characteristics of this population. METHODS: A prospective analysis of genotypic resistance was carried out in 125 patients by gene sequencing (88.0% diagnosed in 2002, 28.9% in 2003-2004, and 87.9% in 2005). Thirteen patients had a diagnosis of recent primary infection. RESULTS: Sixteen patients (12.8%) carried viruses with at least one drug-resistance mutation; among them, 4 had recent infection (30.8%) and 12 chronic infection or infection of unknown duration (10.7%). Six patients (4.8%) presented at least one resistance mutation to nucleoside/tide reverse transcriptase inhibitors, 9 patients (7.2%) to non-nucleoside/ tide reverse transcriptase inhibitors inhibitors and 2 patients (1.6%) to protease inhibitors. One patient (0.8%) harbored a multidrug-resistant variant. The frequency of primary resistance was higher in patients with HIV subtype B (15.5%), in the homosexual/bisexual population (17.9%), and in patients diagnosed in 2005 (17.9%). Prevalence increased from 9.3% in 2002 to 16.3% in 2005 in chronically infected patients or those with unknown duration of the infection. CONCLUSIONS: Primary resistance to antiretroviral drugs is high in both recent and chronic HIV infection and has increased in recent years. Genotype resistance testing in patients with a diagnosis of HIV infection is recommended before beginning antiretroviral therapy.
Subject(s)
Anti-HIV Agents/pharmacology , Drug Resistance, Viral , HIV Infections/drug therapy , HIV-1/drug effects , Adult , Anti-HIV Agents/therapeutic use , Atlantic Islands/epidemiology , Drug Resistance, Multiple, Viral/genetics , Drug Resistance, Viral/genetics , Female , Genotype , HIV Infections/epidemiology , HIV Protease/genetics , HIV Protease Inhibitors/pharmacology , HIV Reverse Transcriptase/genetics , HIV-1/genetics , Humans , Male , Middle Aged , Mutation, Missense , Point Mutation , Prospective Studies , Reverse Transcriptase Inhibitors/pharmacology , Spain/epidemiology , Time FactorsABSTRACT
Objetivo. Estudiar la prevalencia de resistencias primarias a los fármacos antirretrovirales en pacientes diagnosticados de infección por virus de la inmunodeficiencia humana (VIH) durante el período 2002-2005 y sus características clínico-epidemiológicas. Pacientes. Se realizó un estudio prospectivo de resistencias genotípicas mediante secuenciación genética de 125 pacientes (88,0% de los pacientes diagnosticados en el año 2002, 28,9% en 2003-2004 y 87,9% en 2005). Trece de ellos se diagnosticaron de infección primaria reciente. Resultados. En 16 pacientes (12,8%) se detectó la presencia de alguna mutación de resistencia, cuatro con infección reciente (30,8%) y 12 con infección crónica o de duración desconocida (10,7%). Seis pacientes (4,8%) presentaron alguna mutación de resistencia a los inhibidores de la transcriptasa inversa análogos de nucleósido/tido, 9 (7,2%) a los no análogos y 2 pacientes (1,6%) a los inhibidores de la proteasa. Un paciente (0,8%) presentó multirresistencia. Se observó un mayor porcentaje de resistencias en los pacientes con subtipo B (15,5%), la población homosexual/bisexual (17,9%) y los pacientes diagnosticados en el año 2005 (17,9%). En los pacientes con diagnóstico de infección crónica o de duración desconocida, la tasa de resistencia aumentó desde un 9,3% en el año 2002 hasta un 16,3% en 2005. Conclusiones. La tasa global de resistencia a los fármacos antirretrovirales es elevada, tanto en pacientes con infección reciente como crónica, con una tendencia a aumentar en los últimos años. Las pruebas de detección de resistencias se deberían de realizar a todos los pacientes antes de iniciar el tratamiento (AU)
Background. This study examines the prevalence of primary resistance to antiretroviral drugs in patients diagnosed with HIV infection during 2002 to 2005 and determines the clinical and epidemiological characteristics of this population. Methods. A prospective analysis of genotypic resistance was carried out in 125 patients by gene sequencing (88.0% diagnosed in 2002, 28.9% in 2003-2004, and 87.9% in 2005). Thirteen patients had a diagnosis of recent primary infection. Results. Sixteen patients (12.8%) carried viruses with at least one drug-resistance mutation; among them, 4 had recent infection (30.8%) and 12 chronic infection or infection of unknown duration (10.7%). Six patients (4.8%) presented at least one resistance mutation to nucleoside/tide reverse transcriptase inhibitors, 9 patients (7.2%) to non-nucleoside/ tide reverse transcriptase inhibitors inhibitors and 2 patients (1.6%) to protease inhibitors. One patient (0.8%) harbored a multidrug-resistant variant. The frequency of primary resistance was higher in patients with HIV subtype B (15.5%), in the homosexual/bisexual population (17.9%), and in patients diagnosed in 2005 (17.9%). Prevalence increased from 9.3% in 2002 to 16.3% in 2005 in chronically infected patients or those with unknown duration of the infection. Conclusions. Primary resistance to antiretroviral drugs is high in both recent and chronic HIV infection and has increased in recent years. Genotype resistance testing in patients with a diagnosis of HIV infection is recommended before beginning antiretroviral therapy (AU)
