Human immunodeficiency virus type 1 infection in Oman: antiretroviral therapy and frequencies of drug resistance mutations.

AIDS Res Hum Retroviruses 2004 Nov;20(11):1166-72

Department of Microbiology and Immunology, College of Medicine and Health Sciences, Sultan Qaboos University, Muscat, PC 123 Oman.

Highly active antiretroviral therapy (HAART), consisting mainly of two nucleoside reverse transcriptase inhibitors (NRTIs) and one protease inhibitor (PI), is offered to < 10% of HIV-infected subjects in Oman. The aims of the present study were to determine the frequency of resistance-associated mutations in these patients, and to assess the contribution of drug resistance to treatment outcome. Among 29 patients on HAART for > or =6 months, virological, failure was observed in 27 (93%). Genotypic analysis indicated that in five of these 27 patients, there were no mutations that confer resistance to reverse transcriptase inhibitors (RTIs). The genotypes of 17 other patients carried one or two RTI mutations, mainly the lamivudine-associated resistance mutation M184V. Three or more RTI mutations were found in only five (14.7%) patients with virological failure, including three patients on the nonnucleoside RTI efavirenz. Major PI mutations were infrequent, and were detected in seven (26%) of 27 patients failing HAART, mainly as single mutation at codons 82 or 90. In contrast, accessory mutations in the protease gene were present in all patients. However, there were significant differences in the prevalence of accessory mutations at codons 36 and 77 among clade B and non-B viruses. When genotypic data of this study were used to change therapy of seven patients whose isolates had multiple resistance mutations, adequate viral suppression was observed in five. Our results indicate that the high rate of treatment failure among patients in Oman is mainly due to factors other than resistance to antiretroviral drugs. These factors, which may include nonadherence to therapy and treatment interruptions, need to be investigated.

Download full-text PDF

Source
http://dx.doi.org/10.1089/aid.2004.20.1166DOI Listing
November 2004

Publication Analysis

Top Keywords

patients
10
mutations
9
resistance mutations
8
drug resistance
8
reverse transcriptase
8
transcriptase inhibitors
8
accessory mutations
8
virological failure
8
antiretroviral therapy
8
rti mutations
8
resistance
6
mutations infrequent
4
infrequent detected
4
detected 26%
4
major mutations
4
efavirenz major
4
three patients
4
patients nonnucleoside
4
nonnucleoside rti
4
rti efavirenz
4

Similar Publications