title: [Factors associated with resistance to human immunodeficiency virus protease inhibitors].
abstract: BACKGROUND
  To assess the risk factors associated with genotypic resistance to protease inhibitors (PI) in HIV-infected subjects with virologic failure despite highly active antiretroviral treatment (HAART).
  
  
  METHODS
  Retrospective chart review including 47 consecutive patients with virologic failure despite PI-based HAART who had undergone a genotypic HIV-1 testing. The prevalence of genotypic resistance to PI was determined and several demographic, clinical and laboratory variables were compared between patients with and without genotypic resistance to those drugs.
  
  
  RESULTS
  The entire nucleotide sequence of the protease gene was obtained in 43 of the 47 patients; 18 of them had genotypic resistance to PI. Genotypic resistance to PI was associated with a previous therapy with suboptimal antiretroviral regimens (OR = 10.2; 95% CI, 1.05-245.1; P = 0.02), duration of antiretroviral therapy longer than 18 months (OR = 13.3; 95% CI, 1.23-340.85; P = 0.01), greater number of antiretroviral regimens and drugs before the virologic failure (p < 0.01) and presence of the 184V mutation in the reverse transcriptase gene (OR = 5.6; 95% CI, 1.2-29.2; P = 0.02). There was no relationship between PI resistance and the risk group, viral load or CD4 cell count. In the multivariate analysis, previous therapy with suboptimal antiretroviral regimens was the better predictor of PI resistance (OR = 11.1; 95% CI, 1.04-117.47; P = 0.046).
  
  
  CONCLUSIONS
  Patients treated with suboptimal antiretroviral activity regimens before starting HAART can be at greater risk of developing genotypic resistance to protease inhibitors.
authors.affiliation: Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Alicante. Spain. jmoltomar@hotmail.com
authors.forename: José
authors.initials: J
authors.lastname: Moltó
authors.forename: Félix
authors.initials: F
authors.lastname: Gutiérrez
authors.forename: Antonia
authors.initials: A
authors.lastname: Mora
authors.forename: María del Mar
authors.initials: Mdel M
authors.lastname: Masiá
authors.forename: Clara
authors.initials: C
authors.lastname: Escolano
authors.forename: Eva
authors.initials: E
authors.lastname: González
authors.forename: Sergio
authors.initials: S
authors.lastname: Padilla
authors.forename: Juan
authors.initials: J
authors.lastname: Córdoba
authors.forename: Alberto M
authors.initials: AM
authors.lastname: Hidalgo
mesh_terms: D000328:Adult; D000368:Aged; D024882:Drug Resistance, Viral; D005260:Female; D006678:HIV / Q000201:enzymology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011480:Protease Inhibitors; D012189:Retrospective Studies; D012191:Retroviridae Proteins / Q000187:drug effects*
chemical_list: D011480:Protease Inhibitors; D012191:Retroviridae Proteins
vernacular_title: Factores asociados a la resistencia a los inhibidores de la proteasa del virus de la inmunodeficiencia humana.