Please use this identifier to cite or link to this item: http://repositorio.unicamp.br/jspui/handle/REPOSIP/327747
Type: Artigo
Title: Extensive Variation In Drug-resistance Mutational Profile Of Brazilian Patients Failing Antiretroviral Therapy In Five Large Brazilian Cities
Author: Brites
Carlos; Pinto-Neto
Lauro; Medeiros
Melissa; Nunes
Estevao; Sprinz
Eduardo; Carvalho
Mariana
Abstract: Development of drug-resistance mutations is the main cause of failure in antiretroviral therapy. In Brazil, there is scarce information on resistance pattern for patients failing antiretroviral therapy. Objectives: To define the HIV mutational profile associated with drug resistance in Brazilian patients from 5 large cities, after first, second or further failures to antiretroviral therapy. Methods: We reviewed genotyping results of 1520 patients failing therapy in five Brazilian cities. Frequency of mutations, mean number of active drugs, viral susceptibility to each antiretrovirals drug, and regional differences were assessed. Results: Mean time of antiretrovirals use was 22.7 +/- 41.1 months. Mean pre-genotyping viral load was 4.2 +/- 0.8 log (2.1 +/- 2.0 after switching antiretrovirals). Mean number of remaining active drugs was 9.4, 9.0, and 7.9 after 1st, 2nd, and 3rd failure, respectively. We detected regional variations in drug susceptibility: while BA and RS showed the highest (similar to 40%) resistance level to ATV/r, FPV/r and LPV/r, in the remaining cities it was around half of this rate. We detected 90% efavirenz/nevirapine resistance in SP, only 45% in RS, and levels between 25% and 30% in the other cities. Regarding NRTI, we found a similar pattern, with RJ presenting the highest, and CE the lowest susceptibility rates for all NRTI. Zidovudine resistance was detected in only 3% of patients in RJ, against 45-65% in the other cities. RJ and RS showed 3% resistance to tenofovir, while in CE it reached 55%. DRV/r (89-97%) and etravirine (61-85%) were the most active drugs, but again, with a wide variation across cities. Conclusions: The resistance mutational profile of Brazilian patients failing antiretroviral therapy is quite variable, depending on the city where patients were tested. This variation likely reflects distinctive choice of antiretrovirals drugs to initiate therapy, adherence to specific drugs, or circulating HIV-1 strains. Overall, etravirine and DRV/r remain as the most active drugs. (C) 2016 Elsevier Editora Ltda.
Subject: Hiv
Resistance
Brazil
Mutations
Editor: Elsevier Brazil
Rio de Janeiro
Rights: fechado
Identifier DOI: 10.1016/j.bjid.2016.03.010
Address: http://www-sciencedirect-com.ez88.periodicos.capes.gov.br/science/article/pii/S141386701630085X?via%3Dihub
Date Issue: 2016
Appears in Collections:Unicamp - Artigos e Outros Documentos

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