[Factors associated with resistance to human immunodeficiency virus protease inhibitors].
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.
Moltó
José
J
Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital General Universitario de Elche, Alicante. Spain. jmoltomar@hotmail.com
Gutiérrez
Félix
F
Mora
Antonia
A
Masiá
María del Mar
Mdel M
Escolano
Clara
C
González
Eva
E
Padilla
Sergio
S
Córdoba
Juan
J
Hidalgo
Alberto M
AM
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*
D011480:Protease Inhibitors; D012191:Retroviridae Proteins
Factores asociados a la resistencia a los inhibidores de la proteasa del virus de la inmunodeficiencia humana.