[Efficacy of anti-HIV treatment and drug-resistance mutations in some parts of China].
OBJECTIVE
To evaluate the Virologic and Immunologic efficacy of HAART on Chinese HIV/AIDS patients and to assess the impact of of HAART on drug resistance mutations.


METHODS
Three cohorts of Liaoning, Jilin and Henan province received three different regimens for 6 months respectively. Regimen of Liaoning cohort comprised Efavirenz + Indinavir (EFV + IDV), regimen of Jilin cohort comprised Stavudine + Didanosine + Efavirenz (d4T + ddI + EFV) and regimen of Henan cohort comprised Stavudine + Didanosine + Nevirapine (d4T + ddI + NVP). Viral load, CD4(+) T cell count and drug resistance genotype were detected on the three cohorts before and after treatment. Partial HIV-1 pol genes encoding protease and 1 - 220 amino acid of reverse transcriptase were amplified by RT-PCR and then automatically sequenced. All sequences were compared with the data of Stanford HIV Drug Resistance Database to assess resistance mutations against reverse transcriptase inhibitors (RTIs) and protease inhibitors (PIs).


RESULTS
During observation of 6 months, viral suppression to undetectable level and Elevated CD4(+)T cell count efficacy were achieved on partial Chinese HIV/AIDS patients in each of the three different regimens, even in some patients with rather low CD4(+)T cell count baseline. Before HAART, no primary mutations against PIs and RTIs were detected on the three cohorts, except one patient in Liaoning cohort. But after HAART, drug resistance mutations against RTIs occurred on each of the three cohorts. K103N is the most common mutation against NNRTIs, which can cause high-level resistance to each of the available NNRTIs. Y181C is another common mutation occurred in Henan cohort, which causes crossing drug resistance and multi-drug resistance to NNRTIs. In addition, intermediate level and low level resistance against NRTIs caused by K65R and L74V can also be found, but less commonly.


CONCLUSIONS
Treatment naive Chinese HIV/AIDS patients were sensitive to HAART. Expected virologic and immunologic efficacy of HAART were achieved on Chinese HIV/AIDS patients, but after the introduce of HAART, the high prevalence of drug resistance mutations against NNRTIs and NRTIs, crossing drug resistance and multi-drug resistance reminded us to pay more attention to the drug resistance mutations detection, treatment standardization, and to avoid drugs wasting and prevent the prevalence of drug resistance strains.
Han
Xiao-xu
XX
1st Affiliated Hospital, China Medical University, Shenyang 110001, China.
Zhang
Min
M
Cui
Wei-guo
WG
Liu
Bao-gui
BG
Wang
Ya nan
Yn
Zhang
Zi-ning
ZN
Liu
Jing
J
Geng
Wen-qing
WQ
Diao
Ying-ying
YY
Dai
Di
D
Jiang
Yong-jun
YJ
Shang
Hong
H
D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D048588:Benzoxazines; D018791:CD4 Lymphocyte Count; D003521:Cyclopropanes; D016049:Didanosine / Q000627:therapeutic use; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy*; D015497:HIV-1; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation; D019829:Nevirapine / Q000627:therapeutic use; D010078:Oxazines / Q000627:therapeutic use; D018119:Stavudine / Q000627:therapeutic use; D019562:Viral Load
D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D010078:Oxazines; D019829:Nevirapine; D018119:Stavudine; C098320:efavirenz; D016049:Didanosine