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High frequency of antiviral drug resistance and non-B subtypes in HIV-1 patients failing antiviral therapy in Cuba

2012; Elsevier BV; Volume: 55; Issue: 4 Linguagem: Inglês

10.1016/j.jcv.2012.08.019

1873-5967

Vivian Kourí, Yoan Alemán‬, Lissette Pérez, Jorge Pérez, Carlos Alberto da Fonseca, Consuelo Correa, Carlos Aragonés, Jorge Campos, Delmis Álvarez, Yoeri Schrooten, Nathalie Dekeersmaeker, Stijn Imbrechts, Gertjan Beheydt, Lore Vinken, Daniel I. Pérez, Alina Álvarez, Yudira Soto, Anne–Mieke Vandamme, Kristel Van Laethem,

Pneumocystis jirovecii pneumonia detection and treatment

Emergence of HIV-1 drug resistance may limit the sustained benefits of antiretroviral therapy (ART) in settings with limited laboratory monitoring and drug options. Surveillance of drug resistance and subtypes in HIV-1 patients failing ART in Cuba. This study compiled data of ART-experienced HIV-1 patients attending a clinical center in Havana in 2003 and 2009–2011. The first period included results of a cross-sectional study, whereas in the second period genotyping was performed as part of routine care. Drug resistance mutations and levels were determined using HIVdb version 6.0.9. Seventy-six percent received solely ART containing at least 3 drugs, of which 79.1% ever receiving unboosted protease inhibitors (PI). Patients from 2009 to 2011 were longer treated and exposed to more ART regimens. Subtype B (39%) and CRF19_cpx (18%) were the most prevalent genetic forms. Subtype distribution did not change significantly between both periods, except for BG recombinants that increased from 6% to 14%. Nucleoside reverse transcriptase inhibitor (NRTI), non-nucleoside RTI (NNRTI) and PI mutations were present in 69.5%, 54.8% and 44.4%. Full-class resistance (FCR) to NRTI, NNRTI, PI and multidrug resistance (MDR) were detected in 31.8%, 37.9%, 18.5% and 15.4%. FCR to NRTI, NNRTI, PI and MDR were present in 9.8%, 14.1%, 0%, 0% after first-line failure and in 19.8%, 20.8%, 2.9% and 2.9% after second-line failure. Our study found a high prevalence of drug resistance and supports the need for appropriate laboratory monitoring in clinical practice and access to drug options in case of virological failure.