title: Broad phenotypic cross-resistance to elvitegravir in HIV-infected patients failing on raltegravir-containing regimens.
abstract: The failure of raltegravir (RAL) is generally associated with the selection of mutations at integrase position Y143, Q148, or N155. However, a relatively high proportion of failures occurs in the absence of these changes. Here, we report the phenotypic susceptibilities to RAL and elvitegravir (EVG) for a large group of HIV-infected patients failing on RAL-containing regimens. Plasma from HIV-infected individuals failing on RAL-containing regimens underwent genotypic and phenotypic resistance testing (Antivirogram v2.5.01; Virco). A control group of patients failing on other regimens was similarly tested. Sixty-one samples were analyzed, 40 of which belonged to patients failing on RAL-containing regimens. Full RAL susceptibility was found in 20/21 controls, while susceptibility to EVG was diminished in 8 subjects, with a median fold change (FC) of 2.5 (interquartile range [IQR], 2.1 to 3.1). Fourteen samples from patients with RAL failures showed diminished RAL susceptibility, with a median FC of 38.5 (IQR, 10.8 to 103.2). Primary integrase resistance mutations were found in 11 of these samples, displaying a median FC of 68.5 (IQR, 23.5 to 134.3). The remaining 3 samples showed a median FC of 2.5 (IQR, 2 to 2.7). EVG susceptibility was diminished in 19/40 samples from patients with RAL failures (median FC, 7.71 [IQR, 2.48 to 99.93]). Cross-resistance between RAL and EVG was high (R(2) = 0.8; P < 0.001), with drug susceptibility being more frequently reduced for EVG than for RAL (44.3% versus 24.6%; P = 0.035). Susceptibility to RAL and EVG is rarely affected in the absence of primary integrase resistance mutations. There is broad cross-resistance between RAL and EVG, which should preclude their sequential use. Resistance to EVG seems to be more frequent and might be more influenced by integrase variability.
authors.affiliation: Hospital Carlos III, Madrid, Spain. garridocarolina@yahoo.es
authors.forename: Carolina
authors.initials: C
authors.lastname: Garrido
authors.forename: Jorge
authors.initials: J
authors.lastname: Villacian
authors.forename: Natalia
authors.initials: N
authors.lastname: Zahonero
authors.forename: Theresa
authors.initials: T
authors.lastname: Pattery
authors.forename: Federico
authors.initials: F
authors.lastname: Garcia
authors.forename: Felix
authors.initials: F
authors.lastname: Gutierrez
authors.forename: Estrella
authors.initials: E
authors.lastname: Caballero
authors.forename: Margriet
authors.initials: M
authors.lastname: Van Houtte
authors.forename: Vincent
authors.initials: V
authors.lastname: Soriano
authors.forename: Carmen
authors.initials: C
authors.lastname: de Mendoza
mesh_terms: D024882:Drug Resistance, Viral / Q000235:genetics; D005838:Genotype; D015658:HIV Infections / Q000188:drug therapy* / Q000235:genetics*; D019428:HIV Integrase Inhibitors / Q000627:therapeutic use; D006801:Humans; D008969:Molecular Sequence Data; D011760:Pyrrolidinones / Q000627:therapeutic use*; D015363:Quinolones / Q000627:therapeutic use; D000068898:Raltegravir Potassium
chemical_list: D019428:HIV Integrase Inhibitors; D011760:Pyrrolidinones; D015363:Quinolones; D000068898:Raltegravir Potassium; C509700:elvitegravir