RESUMEN
Four patients who had received highly active antiretroviral therapy (HAART), and had postmortem samples stored, were tested for genotypic resistance using consensus sequencing. One patient was further investigated using single-copy sequencing. Patients 1, 3, and 4 showed a relatively uniform distribution of resistance-associated mutations, with only a small number (one to three) of protease mutations detectable. Patient 2 had a number of detectable mutations (four to eight, depending on the tissue) with similar distributions between the tissues. The exception was viruses detected in the esophagus, which were more diverse. Plasma was a moderately representative tissue of the viruses circulating in these individuals. However, some mutations detectable in some tissues were not seen in plasma (e.g., M46I and D30N in the protease). Single-copy sequencing revealed a wide distribution of quasi-species and a number of defective viruses in the proviral DNA and RNA. This study supports the concept that a wide variety of quasi-species circulate in each individual and that there may be viruses evolving independently in different body compartments.
Asunto(s)
Terapia Antirretroviral Altamente Activa , Farmacorresistencia Viral/genética , VIH-1/efectos de los fármacos , Mutación , Especificidad de Órganos , Adulto , Autopsia , Genotipo , Infecciones por VIH/tratamiento farmacológico , Infecciones por VIH/virología , Proteasa del VIH/genética , Transcriptasa Inversa del VIH/genética , VIH-1/clasificación , VIH-1/genética , VIH-1/aislamiento & purificación , Humanos , Persona de Mediana Edad , Datos de Secuencia Molecular , Análisis de Secuencia de ADN , Carga ViralRESUMEN
Little is known about the natural history of hepatitis C virus (HCV) RNA concentrations over the course of infection. The aim of this study was to describe the natural history of HCV RNA concentrations in 85 HIV negative men with bleeding disorders infected with HCV for up to 30 years. HCV RNA concentrations were measured in yearly serum samples using a branched DNA assay. HCV RNA concentrations increased over time in this cohort. Two years after exposure to HCV, 53% of patients had undetectable concentrations and no patients had levels >7 log(10)(genome Eq/ml); by 20 years, these proportions had changed to 23% and 32% respectively. The RNA concentration correlated strongly with alanine aminotransferase (ALT; correlations of 0.41-0.71 depending on stage of infection) and aspartate aminotransferase (AST; 0.20-0.51) levels. Patients with haemophilia A had significantly higher HCV concentrations than those with other disorders. An effect of HCV genotype on HCV RNA concentrations became nonsignificant after excluding patients who were persistently HCV PCR negative and who could not be genotyped. The correlation of HCV RNA concentrations with other markers of liver function, such as ALT, means that studies with clinical outcomes are required to assess whether HCV RNA concentrations provide additional prognostic information to that provided by these other markers.