Frequency of Genotypic and Phenotypic Drug-Resistant HIV-1 Among Therapy-Naive Patients of the German Seroconverter Study

Abstract

Genotypic and phenotypic resistance of viral reverse transcriptase (RT) and protease (PR) was determined for 64 therapy-naive, HIV-1-infected seroconverters of the German Seroconverter Study coordinated by the Robert Koch-Institut, Berlin. The date of seroconversion of patients and the laboratory, clinical, and therapeutic follow-up data were documented. Samples were collected between 1996 and 1999. Phenotypic resistant HIV-1 were found in 8 (13%) seroconverters; in most cases resistance was weak and mainly directed against RT inhibitors (4 nucleoside reverse transcriptase inhibitors [NRTIs], 2 nonnucleoside reverse transcriptase inhibitors [NNRTIs], 1 combination NRTI/NNRTI). Only one infection with a weak PR inhibitor resistance was identified. Transmission of multidrug-resistant HIV-1 has not yet been observed. Frequently at least one or more amino acid mutations associated with antiretroviral drug resistance were detected by genotypic analysis. The mean number of resistance-associated mutations in the RT of the transmitted virus has increased significantly since 1996. Studies have shown the improved benefit of initial antiretroviral therapy if based on genotypic resistance data. In view of the considerably high level of transmission of resistant HIV-1 in Germany, which is also seen in other studies in Europe and the United States, we suggest determining the genotypic resistance pattern before starting therapy of newly HIV-1-infected patients.

Diversity and prevalence of antiretroviral genotypic resistance mutations among HIV-1-infected children

“…Os estudos que avaliaram a resistência primária ao HIV demonstraram uma prevalência que varia de 0 a 25% [6][7][8][9][10][11][12] . No…”

“…Nos últimos 10 anos, a prevalência de resistência primá-ria ao HIV tem variado de 0 a 25%, com taxas mais elevadas e crescentes em países com acesso à terapia ARV [6][7][8][9][10][11][12] . No Brasil, apesar da terapia ARV ser gratuita, nos últimos 10 anos, ainda observamos baixas taxas de resistência primária [13][14][15][16][17][18][19] , mas não há informações disponíveis sobre as crianças.…”

HIV Drug-resistant Strains as Epidemiologic Sentinels

“…Moreover, we cannot be sure that the trends observed correspond to a real decrease in F R , or are simply fluctuations due to stochastic or sampling phenomena around a monotonically increasing time trend (11,18,25,34,(37)(38)(39). Little et al and Grant et al report trends consistent with the first scenario: the decrease in the fraction of persons infected with an NRTI-resistant strain is followed by an increase and subsequent decrease (11)(12)(13).…”

Humanes Immunschwächevirus (HIV)

“…In Einzelfällen, besonders bei Neugeborenen, ist es indiziert, früh nach Infektionseintritt, d. h. bereits vor oder zu Beginn der Serokonversion, mit der Therapie zu beginnen. Auch bei einer Früh-therapie ist zu prüfen, ob medikamentenresistente Viren übertragen wurden [177][178][179].…”