This study was presented in part at the 17th Conference on Retroviruses and Opportunistic Infections, 16–19 February 2010, San Francisco, CA, USA [Abstract #573].
Comparison of resistance mutation patterns in historical plasma HIV RNA genotypes with those in current proviral HIV DNA genotypes among extensively treated patients with suppressed replication†
Article first published online: 14 MAR 2012
© 2012 British HIV Association
Volume 13, Issue 9, pages 517–525, October 2012
How to Cite
Delaugerre, C., Braun, J., Charreau, I., Delarue, S., Nere, M., de Castro, N., May, T., Marchou, B., Simon, F., Molina, J., Aboulker, J. and the ANRS 138-EASIER study group (2012), Comparison of resistance mutation patterns in historical plasma HIV RNA genotypes with those in current proviral HIV DNA genotypes among extensively treated patients with suppressed replication. HIV Medicine, 13: 517–525. doi: 10.1111/j.1468-1293.2012.01002.x
- Issue published online: 11 SEP 2012
- Article first published online: 14 MAR 2012
- Manuscript Accepted: 23 JAN 2012
- controlled viraemia;
- drug resistance;
- HIV-1 DNA proviral;
- plasma HIV-1 RNA
Heavily treatment-experienced patients with good virological control could be at risk of virological failure on switching to a new regimen if pre-existing drug resistance is not taken into account. We examined whether genotyping based on cellular HIV-1 DNA during controlled viraemia identifies resistance mutations detected in plasma HIV-1 RNA during treatment with previous antiretroviral regimens.
Patients and methods
All 169 patients enrolled in the Agence Nationale de Recherche sur le SIDA (ANRS) 138-intEgrase inhibitor MK_0518 to Avoid Subcutaneous Injections of EnfuviRtide (EASIER) trial had already received three antiretroviral drug classes [nucleoside reverse transcriptase inhibitor (NRTI), nonnucleoside reverse transcriptase inhibitor (NNRTI) and protease inhibitor (PI)] and had plasma HIV-1 RNA < 400 copies/ml at baseline. The results of previous resistance genotyping of plasma HIV-1 RNA in individual patients were compared with those of resistance genotyping of whole-blood HIV-1 DNA at randomization.
A median of 4 plasma RNA genotypes were available for the 169 patients. The median numbers of resistance mutations in HIV-1 RNA and DNA were, respectively, 5 and 4 for NRTIs, 2 and 1 for NNRTIs, and 10 and 8 for PIs. The difference was significant for all three drug classes (P = 0.001). Resistance to at least one antiretroviral drug was detected exclusively in HIV-1 RNA or in DNA in 63% and 13% of patients for NRTI, 47% and 1% of patients for NNRTI, and 50% and 7% of patients for PI, respectively.
This study shows that, among highly treatment-experienced patients on effective highly active antiretroviral therapy, resistance genotyping of HIV-1 DNA detects fewer resistance mutations than previous analyses of HIV-1 RNA. These results have implications for patient management and for the design of switch studies.