title: Changes in the HIV-1 mutational profile before first-line HAART in the RESINA cohort.
abstract: Sporadic observations have shown changing patterns of transmitted drug resistance mutations (TDRMs) in HIV infection even without selection pressure by antiretroviral treatment (ART). Repeated genotypic resistance analyses in treatment-naïve patients were performed, in order to analyze intraindividual variances of resistance patterns over time. Between the years 2001 and 2008 two genotypic resistance tests were performed at different time-points in 49 treatment-naïve HIV-positive patients aged >18 years. Wild-type virus was found at baseline and during follow-up in 31 patients (group A, median time between resistance tests 146 days), while resistance mutations were found either at baseline or during follow-up in 18 patients (group B, median time between resistance tests 297 days). In group B, the pattern of resistance changed in eight out of 18 patients over time, with three patients showing decreasing numbers and five patients showing increasing numbers of resistance mutations. The pattern of resistance mutations remained unchanged in 10 out of 18 patients. The mutational pattern in untreated HIV infection may change over time and a single resistance analysis may underestimate the true prevalence of preserved resistance mutations. If these findings can be confirmed in a larger number of patients, it would be prudent to perform genotypic resistance testing both at baseline and prior to the start of ART in order to capture a more complete picture of preserved mutations before initiating ART.
authors.affiliation: Department of Gaastroenterology, Clinic for Gastroenterology, Hepatology and Infectious Diseases, University Hospital, Düsseldorf, Germany. Stefan.reuter@med.uni-duesseldorf.de
authors.forename: Stefan
authors.initials: S
authors.lastname: Reuter
authors.forename: Mark
authors.initials: M
authors.lastname: Oette
authors.forename: Nadine
authors.initials: N
authors.lastname: Sichtig
authors.forename: Rolf
authors.initials: R
authors.lastname: Kaiser
authors.forename: Melanie
authors.initials: M
authors.lastname: Balduin
authors.forename: Björn
authors.initials: B
authors.lastname: Jensen
authors.forename: Dieter
authors.initials: D
authors.lastname: Häussinger
mesh_terms: D000328:Adult; D044966:Anti-Retroviral Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D015331:Cohort Studies; D024882:Drug Resistance, Viral / Q000235:genetics*; D005260:Female; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D016333:HIV Protease / Q000235:genetics; D054303:HIV Reverse Transcriptase / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics*; D006801:Humans; D008297:Male; D009154:Mutation; D010802:Phylogeny
chemical_list: D044966:Anti-Retroviral Agents; D054303:HIV Reverse Transcriptase; D016333:HIV Protease