Genotypic drug resistance and cause of death in HIV-infected persons who died in 1999.
We analyzed the relationship between viral drug resistance and causes of death in 29 HIV-1-infected patients who had been followed in an HIV-outpatient clinic and died in 1999. Six patients (21%) died with plasma HIV-RNA levels <1000 copies/ml. Seven (24%) died with wild-type (WT) virus in plasma, 6 (21%) had reverse transcriptase (RT) mutations only, 10 (34%) had multidrug-resistant (MDR) virus. The causes of death were not differently distributed among these groups; however, 8 of 16 patients (50%) with resistant viruses died of end-organ failure versus 2 of 7 patients (29%) with WT virus. Seventeen of 32 patients (53%) were thought by their physicians to be noncompliant with prescribed therapy. Major resistance mutations to antiretroviral drugs were present in viruses from at least 55% of our HIV-1-infected patients who died in 1999. Nonetheless, deaths also occurred among patients with well-controlled HIV infection and among patients with WT virus in plasma. Infections related to incomplete immune restoration, inability to maintain suppressive antiretroviral drug levels, and end-organ failures all contribute to mortalities in the era of highly active antiretroviral therapy.
Beinker
N K
NK
Department of Medicine, Division of Infectious Diseases, Center for AIDS Research, Case Western Reserve University and University Hospitals of Cleveland, Ohio, USA.
Mayers
D L
DL
Lange
C G
CG
Valdez
H
H
Sitkins
J
J
Lemonnier
L
L
Chowdhry
T K
TK
Lederman
M M
MM
D000328:Adult; D000368:Aged; D023241:Antiretroviral Therapy, Highly Active; D002423:Cause of Death; D004352:Drug Resistance, Microbial / Q000235:genetics; D018432:Drug Resistance, Multiple / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000401:mortality* / Q000821:virology; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012367:RNA, Viral / Q000097:blood
D012367:RNA, Viral