Study of antiretroviral mutants in HIV patients with treatment failures and the effect of risk factors in the virological failures.
BACKGROUND
Information about HIV phenotypes of resistant to available ART and the influence of different risk factors on virological failures (VF) in Costa Rican HIV positive patients prior or during HAART is unknown.


METHODS
Eighty nine samples, 72 VF and 17 basal (before treatment) were analyzed by examining resistant mutants in reverse transcriptase (RT) and protease (PT) regions using Trugene or LIPA genotyping kits. Sixty eight control patients were selected and relevant information was collected in a questionnaire.


RESULTS
Poor adherence, presence of resistant mutations and number of treatment's changes were the only significant factors found (p = 0.006, 0.04 and 0.01 respectively). From 66 sequenced samples, 78%, 50% and 50% showed resistance to NRTI (nucleoside reverse transcriptase inhibitors), NNRT (non-nucleoside reverse transcriptase inhibitors) and PI (protease inhibitors), respectively. The most frequent mutations were M41L, M184V, and T215FY in RT and L62PI, L10FIRV and M36I in PT.


CONCLUSIONS
The most important factor related to treatment response in this study was adherence to treatment. Mutations in RT were related to the treatment failure while the ones found in PT were secondary mutations which have been previously described to influence the selection of primary resistance mutations in these regions. The study reveals the urgency to detect resistant mutations in VF to be considered by physicians for selection of treatment schedule, to analyze basal HIV patients for monitoring of the spread of resistant mutations and the importance to reinforce the adherence in the patients for overall treatment outcome.
Louisiana State University, International Center for Medical Research and training, San José, Costa Rica. icmrtlsu@racsa.co.cr
Lizeth
L
Taylor-Castillo
Gisela
G
Herrera-Martínez
María Paz
MP
León-Bratti
Ricardo
R
Boza
Bernal
B
León-Rodríguez
Ronald B
RB
Luftig
Kirsten
K
Visoná
D000328:Adult; D019380:Anti-HIV Agents / Q000009:adverse effects / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D016022:Case-Control Studies; D024921:Drug Resistance, Multiple, Viral / Q000235:genetics; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000235:genetics / Q000821:virology*; D016333:HIV Protease / Q000235:genetics*; D054303:HIV Reverse Transcriptase / Q000235:genetics*; D015497:HIV-1 / Q000187:drug effects / Q000201:enzymology / Q000235:genetics*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009154:Mutation / Q000235:genetics*; D010349:Patient Compliance; D012307:Risk Factors; D011795:Surveys and Questionnaires; D017211:Treatment Failure; D019562:Viral Load
D019380:Anti-HIV Agents; D054303:HIV Reverse Transcriptase; D016333:HIV Protease