The association between primary antiretroviral resistance and HAART virologic failure in a developing set

• Published in: AIDS research and human retroviruses Vol. 27; no. 3; p. 251
• Main Authors: Gagliani, Luiz Henrique, Alkmim Maia, Wagner T, Sá-Filho, Dercy, Janini, Luiz Mario, Sucupira, Maria Cecilia, Caseiro, Marcos Montani, Diaz, Ricardo Sobhie
• Format: Journal Article
• Language: English
• Published: United States 01.03.2011
• Subjects: Adult; Aged; Aged, 80 and over; Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; Antiretroviral Therapy, Highly Active; Brazil; Case-Control Studies; CD4 Lymphocyte Count; CD4-Positive T-Lymphocytes; CD8-Positive T-Lymphocytes; Drug Resistance, Viral - drug effects; Drug Resistance, Viral - genetics; Female; HIV Infections - drug therapy; HIV Infections - genetics; HIV Infections - virology; HIV-1 - classification; HIV-1 - drug effects; HIV-1 - genetics; Humans; Male; Microbial Sensitivity Tests; Middle Aged; Mutation; Retrospective Studies; Viral Load; Brazil
• ISSN: 1931-8405
• DOI: 10.1089/aid.2010.0150

Santos is a Brazilian port city with high HIV incidence, high primary antiretroviral resistance levels, high HIV-1 BF recombinants prevalence, and high rates of antiretroviral virologic failure. We evaluated factors related to virologic failure after 48 weeks of HAART in this population. We compared demographic and HIV profiles among 43 individuals with virologic failure (group 1) and 37 with virologic success (group 2) after 48 weeks of HAART initiation. The overall primary antiretroviral resistance prevalence was 31.2%; 46.5% in group 1 and 13.5% in group 2 (p < 0.005). Nine patients from group 1 and seven from group 2 were infected by F or BF strains. Fifteen individuals presented with NRTI mutations, 13 with NNRTI mutations, three with PI mutations, and five with NRTI and NNRTI mutations. No significant differences were observed in baseline viral load, CD4, clade assignment, antiretrovirals used, or demographics among groups or patients harboring resistant versus wild-type viruses. In this region, there was a high prevalence of antiretroviral resistance among long standing infected patients whose disease had progressed. This finding supports the concept that resistance testing prior to ART initiation is cost effective. The association between primary antiretroviral resistance and virologic failure may suggest that primary resistance greatly impairs antiretroviral activity.