J Korean Med Sci.  2009 Dec;24(6):1031-1037. 10.3346/jkms.2009.24.6.1031.

Antiretroviral Genotypic Resistance Mutations in HIV-1 Infected Korean Patients with Virologic Failure

• Chin BS
• Choi JY
• Choi JY
• Kim GJ
• Kee MK
• Kim JM
• Kim SS

• KMID: 1783129
• DOI: http://doi.org/10.3346/jkms.2009.24.6.1031

Abstract

Resistance assays are useful in guiding decisions for patients experiencing virologic failure (VF) during highly-active antiretroviral therapy (HAART). We investigated antiretroviral resistance mutations in 41 Korean human immunodeficiency virus type 1 (HIV-1) infected patients with VF and observed immunologic/virologic response 6 months after HAART regimen change. Mean HAART duration prior to resistance assay was 45.3+/-27.5 months and commonly prescribed HAART regimens were zidovudine/lamivudine/nelfinavir (22.0%) and zidovudine/lamivudine/efavirenz (19.5%). Forty patients (97.6%) revealed intermediate to high-level resistance to equal or more than 2 antiretroviral drugs among prescribed HAART regimen. M184V/I mutation was observed in 36 patients (87.7%) followed by T215Y/F (41.5%) and M46I/L (34%). Six months after resistance assay and HAART regimen change, median CD4+ T cell count increased from 168 cells/microliter (interquartile range [IQR], 62-253) to 276 cells/microliter (IQR, 153-381) and log viral load decreased from 4.65 copies/mL (IQR, 4.18-5.00) to 1.91 copies/mL (IQR, 1.10-3.60) (P<0.001 for both values). The number of patients who accomplished viral load <400 copies/mL was 26 (63.4%) at 6 months follow-up. In conclusion, many Korean HIV-1 infected patients with VF are harboring strains with multiple resistance mutations and immunologic/virologic parameters are improved significantly after genotypic resistance assay and HAART regimen change.

Keyword

HIV-1; Treatment Failure; Drug Resistance; Genotype

MeSH Terms

Adult
Aged
*Antiretroviral Therapy, Highly Active
Biological Assay/methods/utilization
Drug Resistance, Viral/*genetics
Female
HIV Infections/*drug therapy/genetics
HIV-1/*genetics
Humans
Male
Middle Aged
*Mutation
Treatment Outcome
Viral Load
Young Adult

Figure

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  Fig. 1 Eligible case selection for analysis of virologic and immunologic response after genotypic resistance assay and HAART regimen change in virologic failure patients. *Virologic failure was defined as log value of ≥3 in viral loads occurring more than twice during 6 months prior to resistance assay referral.

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