Changes in the HIV-1 Mutational Profile Before First-line HAART in the RESINA Cohort
Résumé
Objectives: Sporadic observations have shown changing patterns of transmitted drug resistance mutations (TDRMs) in HIV-infection even without selection pressure by antiretroviral treatment. Repeated genotypic resistance analyses in treatment-naïve patients was performed, in order to analyze intraindividual variances of resistance patterns over time. Patients and Methods: Between the years 2001 and 2008 two genotypic resistance tests were performed at different time-points in 49 treatment-naïve HIV-positive patients aged >18 years. Results: Wild-type virus was found at baseline and during follow-up in 31 patients (group A, median time between resistance tests 146 days), while resistance mutations were found either at baseline or during follow-up in 18 patients (group B, median time between resistance tests 297 days). In group B, the pattern of resistance changed in 8 out of 18 patients over time, with 3 patients showing decreasing numbers and 5 patients showing increasing numbers of resistance mutations. The pattern of resistance mutations remained unchanged in 10 out of 18 patients. Conclusions: The mutational pattern in untreated HIV-infection may change over time and a single resistance analysis may underestimate the true prevalence of preserved resistance mutations. If these findings can be confirmed in a larger number of patients, it would be prudent to perform genotypic resistance testing both at baseline and prior to the start of antiretroviral treatment in order to capture a more complete picture of preserved mutations before initiating antiretroviral treatment.
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