Prevalence of primary resistance at baseline in acutely and recently infected subjects enrolled in AIDS clinical trials group protocol 371.
Prevalence of primary resistance at baseline in acutely and recently infected subjects enrolled in AIDS clinical trials group protocol 371.
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参加艾滋病临床试验组方案 371 的急性和最近感染受试者的基线原发性耐药患病率。
DOI：
10.1097/qai.0b013e3181d5a800
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发表时间：
2010
期刊：
影响因子：
--
通讯作者：
Demeter,LisaM
中科院分区：
文献类型：
--
作者：
Dykes,Carrie;Mukherjee,ALisa;Bosch,RonaldJ;Connick,Elizabeth;Volberding,PaulA;Demeter,LisaM
Supported by the AIDS Clinical Trials Group, under the National Institute of Allergy and infectious Diseases grants AI-68636, AI-38858 and AI-69450. This work was also supported by the Statistical and Data Management Center (SDAC) grant numbers AI-38885 and AI-68634, the University of Rochester CTU (U01 AI-69511) and Developmental Center for AIDS Research (P30 AI-078498), the University of Colorado Health Sciences Center CTU (U01 AI-69450), the UCSF-GIVI CTU (U01 AI-069502) and the Center for AIDS Research (P30 AI-027763).132| www. jaids. com J Acquir Immune Defic Syndr Volume 55, Number 1, September 1, 2010 resistance mutations except for secondary protease mutations. There was no difference in the proportion of recent or acutely infected subjects with all mutations including atypical mutations (Table 1). Acute subjects were more likely to have primary HIV infection symptoms within 1 month before enrollment (acute with infection symptoms 92% versus recent with infection symptoms 31%; P< 0.0001). However, there was no difference in primary HIV infection symptoms among acute and recent subjects who harbored resistant virus versus those who did not (P= 0.99). There was also no difference in the prevalence of mutations in subjects from different trial sites or regions (data not shown). There was also no difference in the percentage of subjects with resistant versus nonresistant virus who achieved a viral load< 50 copies between weeks 8 and 48 after treatment initiation (94% versus 91%; P= 0.99), who underwent treatment interruptions (41% versus 62%; P= 0.12), and who were virologically successful defined as plasma HIV RNA concentration< 5000 copies per milliliter after 24 weeks of treatment interruption (24% versus 23%; P= 0.99). This is the first study to compare the frequency of antiretroviral drug resistance in patients who were acutely infected versus those who were recently infected with HIV. No significant differences in the frequency of drug resistance, the frequency of resistance for each class of drug, or the frequency of atypical mutations were found between the 2 groups. This observation is compatible with previous studies demonstrating slow reversion of transmitted drugresistant variants. 10, 11 This slow reversion could reflect the lack of viral diversity early in infection or may reflect selection for relatively fit viral variants during the process of transmission. Consistent with other studies in recently infected, 12, 13 secondary protease resistance mutations were seen in more than half of the cohort, with 64%(73 of 114) of subjects having 1 or more mutations. These data suggest that secondary mutations may be more readily transmitted than primary mutations. Furthermore, there was no significant difference in clinical outcomes between subjects with and without drug-resistant virus including the ability to control viremia upon treatment interruption. The prevalence of antiretroviral drug resistance in this cohort overall (15%) was comparable to previous studies in recently infected subjects with prevalences ranging from 1%–19%. 1 The prevalence of nRTI, NNRTI, and PI resistance was similar to a previous study of similar size. 14 However, Little et al2 identified NNRTI resistance in 12 of 14 (86%) acutely and recently infected subjects with any primary drug resistance mutations compared with 6 of 17 (35%) in this study. One potential explanation for this difference is geographic variation in the prevalence of transmitted NNRTI resistance. Although we observed no difference in prevalence of resistance by geographical region in our study, the sample size and number of geographical regions likely limited the …
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