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Abstract
Resistance to NNRTI and relationship with adherence
G C Orofino1, M Bolgiani2, S Carosella1, A Di Garbo3, P Caramello1, S Fontana1
1Division A of Infectious Diseases, Amedeo di Savoia Hospital, Torino, Italy; 2Department of Neuoscience, University of Turin, Torino, Italy; 3Laboratorio di Biologia Molecolare, Amedeo di Savoia Hospital, Torino, Italy
Background: Resistance to antiretrovirals, mainly to NNRTI, is a growing problem and a challenge for clinicians. A suboptimal adherence (AD) is the critical factor. Despite guidelines and raccomandations, every clinical centre would create a program to assess AD and sustain non adherent patients. We report here the resistance patterns to NNRTI and correlation with AD.
Methods: Among 550 HIV-1 positive outpatients attending our centre, 430 are on ART and 170 of them have taken an HAART regimen containing at least one NNRTI during the last 3 years. 126 pts (mean age 41 years), with treatment failure, submitted to genotypic resistance testing based on sequencing with Viroseq (Applied Biosystem) has been analysed. 80/126 (63,3%) of them (54 M, 26 F) showed at least a NNRTI resistance ; 7/80 were naive , 73/80 experienced. Risk factors were: 30 IDUs, 28 eterosexual, 20 male omosexual, 2 blood transfusion.. CDC stage was : 34 pts = A, 25 = B, 21 = C. AD was self reported with a questionnaire evaluating the last 4 days. Considered mutations (single or in association) were: K103N, Y181C, Y188L, L100I, K101E/Q/I, V106A,G190A/S/E, M230L, P225H, P236L
Results: 7 genotypes showed mutations only for NNRTI, 36 for NNRTI and NRTI, 3 for NNRTI and PI, 34 for all 3 classes. 25/80 patients (31,2%) reported adherence >95% (group A) , 55/80 (68,8%) <95% (group B). > 3 NNRTI mutations were found in 3 (12%) of the group A and in 11 (20%) of the group B. There is no statistical difference.
Conclusions: NNRTI resistance affects more tan 60% of patients with virological failure; also patients full adherent may select NNRTI resistance, suggesting that other reasons can be explored (PK profile, inter-class resistance); nevertheless, all patients with a NNRTI containig regimen would receive an individualized AD support; the question about the optimal moment to utilize NNRTI remains open.
The XV International AIDS Conference
Abstract no.
WePeB5755
Suggested Citation
" G C Orofino , , et al.
Resistance to NNRTI and relationship with adherence
.
Poster Exhibition:
The XV International AIDS Conference:
Abstract no.
WePeB5755"
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