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The effect of transmitted HIV-1 drug resistance on pre-therapy viral load

By: Contributor(s): Publication details: 2010ISSN:
  • 02699370
Uniform titles:
  • AIDS
Online resources: Summary: <p class="MsoNoSpacing" style="text-align:justify"><span style="font-size: 8pt;"><span style="font-size: 10pt;"><strong><span lang="EN-US">BACKGROUND:</span></strong><span lang="EN-US"> Reduced replication capacity of viruses expressing<span class="apple-converted-space">&nbsp;</span><span class="highlight">drug</span><span class="apple-converted-space">&nbsp;</span>resistantmutations implies that patients with transmitted<span class="apple-converted-space">&nbsp;</span><span class="highlight">drug</span><span class="apple-converted-space">&nbsp;</span>resistance(TDR) could have lower HIV RNA viral load than those infected with wild-typevirus.</span></span></span></p><span style="font-size: 10pt;"></span><p class="MsoNoSpacing" style="text-align:justify"><span style="font-size: 10pt;"><strong><span lang="EN-US" style="text-transform: uppercase;">METHODS:</span></strong><span lang="EN-US" style="text-transform: uppercase;"> </span><span lang="EN-US">We performed analysis using<span class="apple-converted-space">&nbsp;</span><span class="highlight">data</span><span class="apple-converted-space">&nbsp;</span>from the UK HIV<span class="apple-converted-space">&nbsp;</span><span class="highlight">Drug</span><span class="apple-converted-space">&nbsp;</span>ResistanceDatabase and the UK CHIC study. Eligible patients had a resistance testperformed between 1997 and 2007 while naive to antiretroviral therapy, were 16years or older, and had a viral load and CD4 cell count measurement within 6months of this test. Models were adjusted for CD4 cell count, viral subtype,ethnicity, risk group, sex, age, calendar year, clinical centre, and viral loadassay.<span style="text-transform:uppercase"></span></span></span></p><span style="font-size: 10pt;"></span><p class="MsoNoSpacing" style="text-align:justify"><span style="font-size: 10pt;"><strong><span lang="EN-US" style="text-transform: uppercase;">RESULTS:</span></strong><span lang="EN-US" style="text-transform: uppercase;"> </span></span><span lang="EN-US"><span style="font-size: 8pt;"><span style="font-size: 10pt;">Of a total of 7994 patients included, 709 (9%) had TDR: 604 (85%) hadresistance to one<span class="apple-converted-space">&nbsp;</span><span class="highlight">drug</span><span class="apple-converted-space">&nbsp;</span>classonly [350 nucleos(t)ide reverse transcriptase inhibitors (NRTIs), 164non-nucleos(t)ide reverse transcriptase inhibitors (NNRTIs), 90 proteaseinhibitors (PIs)], 77 (11%) to two classes (42 NRTIs/NNRTIs, 31 NRTIs/PIs, 4NNRTIs/PIs), and 28 (4%) had resistance to all three classes. The overall mean(SD) viral load at the time of resistance testing was 4.60 (0.82) log(10)copies/ml, and did not differ by class of TDR. However, patients harbouringM184V/I (n = 61) had a significantly lower viral load [adjusted mean difference-0.33 log10 copies/ml (95% CI -0.54 to -0.11), 53% lower (95% CI 22 to 71%), P= 0.002] compared to wild-type virus.</span></span><span style="font-size: 12pt; text-transform: uppercase; font-family: 'Times New Roman', serif;"></span></span></p>
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&lt;p class="MsoNoSpacing" style="text-align:justify"&gt;&lt;span style="font-size: 8pt;"&gt;&lt;span style="font-size: 10pt;"&gt;&lt;strong&gt;&lt;span lang="EN-US"&gt;BACKGROUND:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US"&gt; Reduced replication capacity of viruses expressing&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;&lt;span class="highlight"&gt;drug&lt;/span&gt;&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;resistantmutations implies that patients with transmitted&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;&lt;span class="highlight"&gt;drug&lt;/span&gt;&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;resistance(TDR) could have lower HIV RNA viral load than those infected with wild-typevirus.&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;span style="font-size: 10pt;"&gt;&lt;/span&gt;&lt;p class="MsoNoSpacing" style="text-align:justify"&gt;&lt;span style="font-size: 10pt;"&gt;&lt;strong&gt;&lt;span lang="EN-US" style="text-transform: uppercase;"&gt;METHODS:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US" style="text-transform: uppercase;"&gt; &lt;/span&gt;&lt;span lang="EN-US"&gt;We performed analysis using&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;&lt;span class="highlight"&gt;data&lt;/span&gt;&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;from the UK HIV&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;&lt;span class="highlight"&gt;Drug&lt;/span&gt;&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;ResistanceDatabase and the UK CHIC study. Eligible patients had a resistance testperformed between 1997 and 2007 while naive to antiretroviral therapy, were 16years or older, and had a viral load and CD4 cell count measurement within 6months of this test. Models were adjusted for CD4 cell count, viral subtype,ethnicity, risk group, sex, age, calendar year, clinical centre, and viral loadassay.&lt;span style="text-transform:uppercase"&gt;&lt;/span&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;&lt;span style="font-size: 10pt;"&gt;&lt;/span&gt;&lt;p class="MsoNoSpacing" style="text-align:justify"&gt;&lt;span style="font-size: 10pt;"&gt;&lt;strong&gt;&lt;span lang="EN-US" style="text-transform: uppercase;"&gt;RESULTS:&lt;/span&gt;&lt;/strong&gt;&lt;span lang="EN-US" style="text-transform: uppercase;"&gt; &lt;/span&gt;&lt;/span&gt;&lt;span lang="EN-US"&gt;&lt;span style="font-size: 8pt;"&gt;&lt;span style="font-size: 10pt;"&gt;Of a total of 7994 patients included, 709 (9%) had TDR: 604 (85%) hadresistance to one&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;&lt;span class="highlight"&gt;drug&lt;/span&gt;&lt;span class="apple-converted-space"&gt;&amp;nbsp;&lt;/span&gt;classonly [350 nucleos(t)ide reverse transcriptase inhibitors (NRTIs), 164non-nucleos(t)ide reverse transcriptase inhibitors (NNRTIs), 90 proteaseinhibitors (PIs)], 77 (11%) to two classes (42 NRTIs/NNRTIs, 31 NRTIs/PIs, 4NNRTIs/PIs), and 28 (4%) had resistance to all three classes. The overall mean(SD) viral load at the time of resistance testing was 4.60 (0.82) log(10)copies/ml, and did not differ by class of TDR. However, patients harbouringM184V/I (n = 61) had a significantly lower viral load [adjusted mean difference-0.33 log10 copies/ml (95% CI -0.54 to -0.11), 53% lower (95% CI 22 to 71%), P= 0.002] compared to wild-type virus.&lt;/span&gt;&lt;/span&gt;&lt;span style="font-size: 12pt; text-transform: uppercase; font-family: 'Times New Roman', serif;"&gt;&lt;/span&gt;&lt;/span&gt;&lt;/p&gt;

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