HIV‐1 genotype resistance pattern and evolution in patients failing nelfinavir‐containing regimens

摘要

Clinical and in vitro studies have suggested that nelfinavir (NFV)‐containing regimens may not preclude the use of other protease inhibitors (PIs) in treatment sequencing. We have studied the prevalence of 30N mutation in a human immunodeficiency virus–1 (HIV‐1)‐infected cohort and the virological response to a PI‐containing regimen in patients who had previously failed NFV. A total of 335 patients were included in the study; 32 of them were antiretroviral‐naïve and 303 were antiretroviral‐experienced (251 were PI‐experienced). Mutations 30N and/or 90M were not detected in sequences obtained either from the antiretroviral naïve or non‐PI‐experienced patients. The 30N mutation was detected in 21/251 (8.3%) of PI‐experienced patients and 90M in 103/251 (41%). Moreover, we have observed that the 88D and 77I mutations were present in more than 75% of patients harbouring the 30N HIV‐1 variant and the 71T mutation was present in almost 50% of them. Finally, mutations 30N+90M were never detected together in the same HIV‐1 strain. The 30N and 90M mutations were not observed together. The presence of mutations at positions 36, 46, 71, 77, and/or 88 in a 30N background, increases the risk of the cross‐resistance to other PIs. The use of NFV as a first‐line PI, as an application of drug sequencing strategies, may help preserve future PI options. J. Clin. Lab. Anal. 19:26–29, 2005. © 2005 Wiley‐Liss, Inc.