ABSTRACT
INTRODUCTION: Highly active antiretroviral therapy (HAART) in HIV patients is considered successful when plasma viral load (VL) reaches < 50 copies/ml. However, many patients have a persistent VL of 50 to 1000 copies/ml, and treatment guidelines do not recommend genotypic resistance testing at these levels because of poor performance. The aim of this study was to evaluate the usefulness of a concentration technique for HIV-1 sequencing in samples with < 1000 copies/ml, and determine the virological consequences of HAART treatment changes guided by resistance testing in this scenario. METHODS: Observational study performed in 51 patients with plasma VL between 50 and 1000 copies/m; 27 patients had these levels for at least 12 consecutive months. Prior to RNA extraction, virions were concentrated from 3-ml plasma samples and then genotyped following standard procedures. RESULTS: Forty-seven of the 51 samples were successfully sequenced, resulting in a sensitivity of 92%. Among these 47 patients, 27 showed a persistent viral load of 50-1000 copies/ml for 12 months, and 20 patients achieved undetectable viral load following the genotype-guided HAART change (intention-to-treat analysis: NC = F; 20 of 27 [74.1%]; on-treatment analysis: 20 of 23 [86.9%]). CONCLUSIONS: We report a simple method for genotype sequencing in patients with persistent low-level viremia that allowed a modification of the HAART regimen leading to undetectable plasma viremia.
Subject(s)
Anti-HIV Agents/pharmacology , Drug Resistance, Multiple, Viral/genetics , HIV Infections/drug therapy , HIV Protease/genetics , HIV Reverse Transcriptase/genetics , HIV-1/genetics , RNA, Viral/genetics , Viremia/drug therapy , Anti-HIV Agents/therapeutic use , Antiretroviral Therapy, Highly Active , HIV Infections/blood , HIV-1/drug effects , HIV-1/enzymology , HIV-1/isolation & purification , Humans , RNA, Viral/isolation & purification , Selection, Genetic , Sequence Analysis, RNA/methods , Viral Load , Viremia/microbiologyABSTRACT
Introducción: se considera éxito terapéutico cuando un paciente con el virus de la inmunodeficiencia humana (VIH) sometido a tratamiento antirretroviral de gran actividad (TARGA) consigue una carga viral plasmática<50copias/ml. Sin embargo, es frecuente encontrar a pacientes cuya carga viral se sitúa en 501.000copias/ml, en estos casos las guías de tratamiento no recomiendan realizar un test genotípico de resistencias aduciendo una baja rentabilidad. El objetivo principal de este estudio fue examinar la utilidad de una técnica de concentración para la secuenciación de VIH-1 desde muestras que contienen menos de 1.000copias/ml, y a partir de aquí determinar las consecuencias virológicas de los cambios guiados por el test de resistencia genotípica del TARGA de estos pacientes. Métodos: se estudió a 51 pacientes con cargas virales de 501.000copias/ml, de los que 27 presentaron estos valores de carga viral durante al menos 12 meses consecutivos. Antes de la extracción del ARN, se concentró una muestra de 3ml de plasma y, a continuación, se genotipó siguiendo el procedimiento estándar. Resultados: se pudo secuenciar 47 muestras de las 51, con una sensibilidad del 92%. De estos 47 pacientes, 27 mantienen carga viral de 501.000copias/ml durante 12 meses, de ellos, 20 consiguen carga viral indetectable al cambiar el TARGA guiado por el genotipo (análisis por intención de tratar; no consta=fracaso; 20 de 27 [74,1%]) (análisis en tratamiento; 20 de 23 [86,9%]).Conclusiones: mostramos una modificación sencilla de la secuenciación genotípica en pacientes con grados de viremia persistentemente bajos, que resulta en una modificación en el régimen del TARGA que consigue una viremia plasmática indetectable (AU)
Introduction: Highly active antiretroviral therapy (HAART) in HIV patients is considered successful when plasma viral load (VL) reaches<50copies/ml. However, many patients have a persistent VL of 50 to 1000copies/ml, and treatment guidelines do not recommend genotypic resistance testing at these levels because of poor performance. The aim of this study was to evaluate the usefulness of a concentration technique for HIV-1 sequencing in samples with<1000copies/ml, and determine the virological consequences of HAART treatment changes guided by resistance testing in this scenario. Methods: Observational study performed in 51 patients with plasma VL between 50 and 1000copies/m; 27 patients had these levels for at least 12 consecutive months. Prior to RNA extraction, virions were concentrated from 3-ml plasma samples and then genotyped following standard procedures. Results: Forty-seven of the 51 samples were successfully sequenced, resulting in a sensitivity of 92%. Among these 47 patients, 27 showed a persistent viral load of 501000copies/ml for 12 months, and 20 patients achieved undetectable viral load following the genotype-guided HAART change (intention-to-treat analysis: NC=F; 20 of 27 [74.1%]; on-treatment analysis: 20 of 23 [86.9%]).Conclusions: We report a simple method for genotype sequencing in patients with persistent low-level viremia that allowed a modification of the HAART regimen leading to undetectable plasma viremia (au)
Subject(s)
Humans , HIV-1/genetics , Acquired Immunodeficiency Syndrome/genetics , Viremia/genetics , Acquired Immunodeficiency Syndrome/drug therapy , Base Sequence , HIV-1/bloodABSTRACT
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Subject(s)
Specimen Handling , Microbiology , Quality Control , Laboratories , Immunologic TestsABSTRACT
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