Anti-retroviral drug resistance evolves as an inevitable consequence of expanded combination Anti-retroviral Therapy (cART). According to each drug class, resistance mutations may occur due to the infidel nature of HIV reverse transcriptase (RT) and inadequate drug pressures. Correspondingly, resistance to Nucleoside Reverse Transcriptase Inhibitors (NRTIs) occurs due to incorporation impairment of the agent or its removal from the elongating viral DNA chain. With regard to Non-Nucleoside Reverse Transcriptase Inhibitors (NNRTIs), resistance mutations may alter residues of the RT hydrophobic pocket and demonstrate high level of cross resistance. However, resistance to Protease Inhibitors requires complex accumulation of primary and secondary mutations that substitute amino acids in proximity to the viral protease active site. Resistance to novel entry inhibitors may also evolve as a result of mutations that affect the interactions between viral glycoprotein and CD4 or the chemokine receptors. According to the current studies, future drug initiative programs should consider agents that possess higher genetic barrier toward resistance for ascertaining adequate drug efficacy among patients who have failed first-line regimens.
Objective:
This study aimed to simultaneously measure and assess in-between correlations of available parameters including HIV-1 p24 Ag and antibody levels, CD4 cell count, and viral load in different stages (A, B, and C) of HIV disease among HIV-positive individuals in Iran.
Materials and methods:
Fifty-two HIV-positive individuals were divided into three groups according to the HIV disease stages classification, available in Control of Disease and Prevention (CDC) guideline. A 10 ml of venous blood sample was collected to run the tests for HIV-1 antibody and p24 Ag levels, CD4 cell counts, and viral load.
Results:
The correlation coefficients between p24 Ag and CD4 cell count in stages A, B and C were, respectively, 0.03, 0.4 and -0.1 (p >0.05). We also found no correlation between the viral load and p24 antigen in stages A, B and C (0.06, -0.07 and -0.22, respectively) (p >0.05). the coefficient was also insignificant for in-between correlation of other measured parameters.
Conclusion:
The association of anti-HIV antibodies with HIV disease progression in infected individuals was independent of HIV-1 RNA levels. However, combined measurement of HIV-1 RNA and CD4 cell counts should be routinely carried out in HIV infected patients follow up.
Our findings are helpful in understanding the demographic, clinical and laboratory profile of people living with HIV/AIDS. Consideration of useful interventions for high- risk groups and paying more attention to socio demographic background are needed for health care providers.
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