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Int J Infect Dis. 2010 Apr;14(4):e298-303. doi: 10.1016/j.ijid.2009.05.006. Epub 2009 Aug 8.

Antiretroviral drug resistance in HIV-infected patients in Colombia.

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1
Emory University School of Medicine, Atlanta, GA 30303, USA. cdiazgr@emory.edu

Abstract

BACKGROUND:

Systematically obtained data on antiretroviral (ARV) resistance in Colombia are lacking. Local estimates of resistance are needed to guide testing, therapy, and policy.

METHODS:

A cross-sectional study was performed in ARV-naïve individuals and in patients with first ARV failure. Genotypic resistance testing was performed using Viro-seq. Predicted success to first- and second-line regimens recommended by the Colombian HIV treatment guidelines was estimated.

RESULTS:

One hundred and three naïve and 77 experienced patients were included. For naïve patients, resistance mutations were detected in 5.8%, with the most common mutations being 103N (n=5; 4.9%) and 184V (n=3; 2.9%). CD4 count <200cells/mm(3) (p=0.04) and Centers for Disease Control and Prevention (CDC) category C (p=0.004) were associated with primary resistance. For experienced individuals, regimens were non-nucleoside reverse transcriptase inhibitor (NNRTI)-based in 57.1%, protease inhibitor (PI)-based in 14.3%, boosted PI-based in 26.0%, and nucleoside reverse transcriptase inhibitor (NRTI)-based in 2.6% of the cases. Resistance mutations were found in 66 patients (85.7%) with failure. The most common mutations were 184V (n=48; 62.3%), 103N (n=37; 48.1%), G190A/S (n=9; 11.7%), and L90M (n=9; 11.7%). Twelve percent had thymidine analogue mutations (TAMs) but only 1% had more than 1 TAM. The predicted success of regimens recommended by the Colombian guidelines was 95% for naïve patients and 84% for experienced patients. Genotyping could increase the success rates to 100% and 94%, respectively.

CONCLUSIONS:

The frequency of primary HIV resistance in Colombia is similar to estimates from other countries in Latin America. CD4 count and CDC category C may allow identification of most of the naïve patients who would benefit from resistance testing. Resistance testing could favorably impact therapy modification in about 5% and 10% of naïve and experienced patients, respectively.

PMID:
19665910
DOI:
10.1016/j.ijid.2009.05.006
[Indexed for MEDLINE]
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