RESUMO
INTRODUCTION: Genotypic resistance was tested to investigate changes in the rates of resistance to antiretroviral drugs in non-treated patients in Spain. MATERIAL AND METHOD: A total of 209 HIV-infected patients from different autonomous communities in Spain without prior antiretroviral (AR) drug treatment were studied from 1997 to 2001. Regions of the HIV pol gene coding for protease (PR) and retrotranscriptase (RT) were sequenced in plasma samples by RT PCR amplification and automated PCR sequencing. RESULTS: At least one primary RT or PR mutation was detected in 14 patients (6.7%); 11 of them were associated with resistance to RT inhibitors (5.3%) and 3 to PR inhibitors (1.4%). The changes in the resistance rate between March 1997-February 1999 and March 1999-February 2001 were as follows: resistance mutations were detected in 3 of the 111 patients studied in the first period, and in 10 of 98 patients in the second period (2.7% versus 10.2%, P = 0.025). The infection time was less than three months in 1.5% of cases, less than 1 year in 13.4%, more than 1 year in 45.9% and unknown in 39.2%. CONCLUSION: The rate of primary resistance in naive patients is low in Spain, although there may be a trend toward an increase. The rising prevalence of resistance is a cause for concern.
Assuntos
Fármacos Anti-HIV/farmacologia , Farmacorresistência Viral/genética , Genes pol , Infecções por HIV/tratamento farmacológico , HIV-1/efeitos dos fármacos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Substituição de Aminoácidos , Fármacos Anti-HIV/uso terapêutico , Criança , Farmacorresistência Viral Múltipla/genética , Feminino , Infecções por HIV/epidemiologia , HIV-1/genética , Humanos , Masculino , Pessoa de Meia-Idade , Mutação de Sentido Incorreto , Mutação Puntual , Reação em Cadeia da Polimerase Via Transcriptase Reversa , Fatores de Risco , Espanha/epidemiologiaRESUMO
Introducción. Para conocer la evolución de la tasa de resistencia a los antirretrovirales en España en pacientes no tratados previamente, estudiamos la resistencia genotípica. Material y método. Se estudiaron muestras plasmáticas de 209 pacientes infectados por el virus de la inmunodeficiencia humana (VIH), procedentes de diversas comunidades autónomas, que no habían recibido tratamiento antirretroviral desde 1997 a 2001. Analizamos la secuencia del gen pol que codifica la proteasa (PR) y la retrotranscriptasa (RT) del VIH usando un sistema de secuenciación automático. Resultados. En 14 pacientes (6,7%) se detectó al menos una mutación en la RT o mutación primaria en la PR. En 11 pacientes, las mutaciones se asociaron a resistencia a los inhibidores de la RT (5,3%) y en tres a los inhibidores de la PR (1,4%). La evolución de la tasa de resistencia entre marzo de 1997 a febrero de 1999 y de marzo de 1999 a febrero de 2001 fue la siguiente: se detectaron mutaciones codificadoras de resistencias en 3 de los 111 pacientes estudiados en el primer período mientras que se identificaron en 10 casos de 98 pacientes en el segundo período (2,7% frente a 10,2%; p = 0,025). En el 1,5% de los casos, el tiempo de la infección fue inferior a 3 meses, en el 13,4% 1 año y en el 39,2% de duración desconocida. Conclusión. El porcentaje de pacientes no tratados previamente con resistencia primaria en España es bajo pero preocupa la probable tendencia a su incremento (AU)
Introduction. Genotypic resistance was tested to investigate changes in the rates of resistance to antiretroviral drugs in non-treated patients in Spain. Material and method. A total of 209 HIV-infected patients from different autonomous communities in Spain without prior antiretroviral (AR) drug treatment were studied from 1997 to 2001. Regions of the HIV pol gene coding for protease (PR) and retrotranscriptase (RT) were sequenced in plasma samples by RT PCR amplification and automated PCR sequencing. Results. At least one primary RT or PR mutation was detected in 14 patients (6.7%); 11 of them were associated with resistance to RT inhibitors (5.3%) and 3 to PR inhibitors (1.4%). The changes in the resistance rate between March 1997-February 1999 and March 1999-February 2001 were as follows: resistance mutations were detected in 3 of the 111 patients studied in the first period, and in 10 of 98 patients in the second period (2.7% versus 10.2%, P = 0.025). The infection time was less than three months in 1.5% of cases, less than 1 year in 13.4%, more than 1 year in 45.9% and unknown in 39.2%. Conclusion. The rate of primary resistance in naive patients is low in Spain, although there may be a trend toward an increase. The rising prevalence of resistance is a cause for concern (AU)
