Intermittent viremia during first-line, protease inhibitors-containing therapy: significance and relationship with drug resistance
| Autor: | Gilles Peytavin, Jacques Reynes, Bernard Masquelier, Edwige Pereira, Rodolphe Garraffo, François Raffi, Diane Descamps, Hervé Fleury, Renaud Verdon, Françoise Brun-Vézinet, Geneviève Chêne |
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| Rok vydání: | 2005 |
| Předmět: |
medicine.medical_specialty
Anti-HIV Agents medicine.medical_treatment HIV Infections Viremia Drug resistance Gastroenterology Persistence (computer science) Virology Internal medicine Drug Resistance Viral Humans Medicine Protease biology business.industry HIV Protease Inhibitors Viral Load biology.organism_classification medicine.disease Infectious Diseases Lentivirus Cohort Immunology HIV-1 Patient Compliance RNA Viral Reverse Transcriptase Inhibitors Drug Therapy Combination Viral disease business HIV drug resistance |
| Zdroj: | Journal of Clinical Virology. 33:75-78 |
| ISSN: | 1386-6532 |
| DOI: | 10.1016/j.jcv.2004.11.012 |
| Popis: | Background: In HIV-infected patients on first-line antiretroviral therapy, the significance of intermittent viremia and their relationship with drug resistance remain unclear. Objective: To study the virological characteristics of intermittent viremia (IV) and the association between IV and later virological failure (VF) in patients on a first-line, PI-containing therapy. Study design: Antiretroviral-naive patients were enrolled in the APROVIR substudy of the prospective, multicenter APROCO cohort at the time they initiated a PI-containing therapy and were followed-up at month 1 and every 2 months. IV was defined as plasma HIV-1 RNA > 500 copies/ml on a single specimen. VF were defined as: (1) viral rebound on two consecutive plasma specimens with HIV-1 RNA > 500 copies/ml after an initial response below 500 copies/ml, or (2) persistence of plasma HIV-1 RNA ≥ 500 copies/ml during the first year of follow-up. Genotypic resistance analysis was performed at baseline and at the time of IV. PI plasma concentrations were determined at the time of IV. Results: IV was found in 20/219 patients in a 2 years follow-up. The occurrence of IV in the first year of therapy was associated with a higher risk of virological failure during the second year (p = 0.03). Genotypic resistance at the time of IV was found in only 4/16 patients and was not predictive of a subsequent virological failure. PI plasma levels suggested lack of adherence in 50% of patients with IV. Conclusion: The occurrence of IV > 500 copies/ml among patients on first-line, PI-containing ART is suggestive of a lack of adherence rather than the selection of resistant variants and should lead to an intensification of adherence monitoring in order to reduce the risk of subsequent VF. |
| Databáze: | OpenAIRE |
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