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1. Updated prevalence of genotypic resistance among HIV-1 positive patients naïve to antiretroviral therapy: a single center analysis.

Author

Lapadula G, Izzo I, Gargiulo F, Paraninfo G, Castelnuovo F, Quiros-Roldan E, Cologni G, Ceresoli F, Manca N, Carosi G, and Torti C

Subjects
Adult, Female, Genes, Viral, Humans, Italy, Male, Middle Aged, RNA, Viral genetics, Amino Acid Substitution genetics, Drug Resistance, Viral, HIV Infections virology, HIV-1 drug effects, HIV-1 genetics, Mutation
Abstract

Continuous surveillance of HIV primary resistance mutations is highly important due to their potential clinical impact. All patients naïve to antiretrovirals who had > or =1 genotypic resistance testing at the Institute of Infectious Diseases (Brescia, Northern Italy) between 2001 and 2006 were analyzed. Primary resistance mutations were defined using epidemiological and clinical criteria. Mutations were interpreted using the Stanford University Algorithm. Logistic regression analysis was used to assess possible predictors of primary resistance mutations. Among 569 patients, 11% presented > or =1 mutation. Prevalence of primary resistance mutations to nucleoside reverse-transcriptase inhibitors (NRTI), non-nucleoside reverse-transcriptase inhibitors (NNRTI), and protease inhibitors (PI) was 6.3%, 6%, and 1.6%, respectively. The most frequent mutations to NRTI were substitutions at position 215 (215Y in 3 patients, and 215 revertants in 16), 41L (13), 219Q (12), and 210W (10). Among mutations to NNRTI, 103N was found in 21 patients, while 181C, 188L, and 190A/S in 8, 3, and 4 patients, respectively. Fifty-one patients (9%) had high-to-intermediate resistance to > or =1 antiretroviral drug before starting the treatment. Regarding the new generation drugs, nine patients had intermediate resistance to etravirine, five patients had intermediate resistance to tipranavir, while five, one, and seven patients had low resistance to etravirine, tipranavir, and darunavir. Homosexuals were more likely to harbor a virus with primary resistance mutations (OR:2.68; 95% CI:1.44-5.00; P = 0.002) while non-Italian nationality was protective (OR:0.38; 95% CI:0.17-0.86; P = 0.020). Prevalence of primary resistance mutations suggests that genotypic resistance testing should be performed before starting treatment in naïve patients in Italy, particularly when NNRTI are prescribed.

Published
2008
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2. Plasma HIV load and proviral DNA decreases after two standard antiretroviral regimens in HIV-positive patients naïve to antiretrovirals.

Author

Torti C, Quiros-Roldan ME, Cologni G, Nichelatti M, Ceresoli F, Pinti M, Nasi M, Cossarizza A, Lapadula G, Costarelli S, Manca N, Gargiulo F, Magoni M, and Carosi G

Subjects
Adenine administration & dosage, Adenine analogs & derivatives, Adult, Alkynes, Antiretroviral Therapy, Highly Active methods, Benzoxazines administration & dosage, Biomarkers, CD4 Lymphocyte Count, Cyclopropanes, DNA, Viral blood, Female, HIV Infections virology, Humans, Lamivudine administration & dosage, Male, Middle Aged, Organophosphonates administration & dosage, Reverse Transcriptase Inhibitors classification, Tenofovir, Treatment Outcome, CD4-Positive T-Lymphocytes virology, DNA, Viral drug effects, Drug Administration Schedule, HIV Infections drug therapy, HIV-1 drug effects, Reverse Transcriptase Inhibitors administration & dosage, Viral Load
Abstract

(i) To compare early decrease of HIV plasma viral load (pVL) after two standard combinations of highly active antiretroviral therapy (HAART). (ii) To evaluate variations of proviral HIV-DNA load on conditions of sustained pVL undetectability. Two different sub-studies of a multicentre prospective randomized controlled trial which compared two first-line HAART (i.e., zidovudine+lamivudine+lopinavir/ritonavir versus tenofovir+lamivudine+ efavirenz). Only patients enrolled at the coordinating centre (University of Brescia) were included in the two sub-studies. In the first sub-study, we calculated pVL decrease with respect to baseline at any of the following time-points: days 1, 3, 7, 14 and 28. Decreases of the pVL were compared between the two treatment groups. In the second sub-study, we analyzed variation of proviral HIV-DNA load in CD4+ T-cells from baseline to week 52 only in patients who maintained the same treatment regimen and had sustained undetectable pVL. In either studies, linear regression analysis was used to investigate what factors could influence variations of pVL and of proviral HIV-DNA load. (i) 64 patients were studied. A significant decrease of pVL was found from day 3 on, without statistically significant differences between the two study groups. However, after adjusting for possible confounders, tenofovir+lamivudine+efavirenz resulted to be associated with greater pVL decreases. (ii) 45 patients were studied. Mean proviral HIV-DNA load decreased from 1,610 (95%CI: 879-2,341) to 896 (95% CI 499-1,293) copies/10(6) cells (P=0.05). Linear regression analysis showed that the decrease of proviral DNA load during follow-up was independently and inversely correlated with age. Further studies are needed to compare pVL decay between antiretroviral regimens and assess whether proviral HIV-DNA load is a surrogate marker of treatment effectiveness.

Published
2008
Full Text
View/download PDF

3. Prevalence and risk factors for etravirine resistance among patients failing on non-nucleoside reverse transcriptase inhibitors.

Author

Lapadula G, Calabresi A, Castelnuovo F, Costarelli S, Quiros-Roldan E, Paraninfo G, Ceresoli F, Gargiulo F, Manca N, Carosi G, and Torti C

Subjects
Adult, CD4 Lymphocyte Count, Female, HIV Infections epidemiology, HIV Infections virology, HIV-1 classification, HIV-1 genetics, Humans, Italy epidemiology, Logistic Models, Male, Microbial Sensitivity Tests methods, Mutation, Nevirapine pharmacology, Nitriles, Prevalence, Pyrimidines, RNA, Viral blood, Risk Factors, Treatment Failure, Anti-HIV Agents pharmacology, Anti-HIV Agents therapeutic use, Drug Resistance, Viral genetics, HIV Infections drug therapy, HIV-1 drug effects, Nevirapine therapeutic use, Pyridazines pharmacology, Reverse Transcriptase Inhibitors pharmacology, Reverse Transcriptase Inhibitors therapeutic use
Abstract

Background: Prevalence and factors associated with etravirine (EW) resistance mutations among patients failing on first-generation non-nucleoside reverse transcriptase inhibitors (NNRTI) merit investigation., Methods: The study comprised an analysis of all sequential patients attending the Institute of Infectious Diseases (Brescia, northern Italy) who performed a genotypic resistance testing (GRT) after > or =3 months of a stable NNRTI-based regimen between 2001 and 2006. Multivariable ordinal logistic regression analysis was performed to assess predictors of ETV resistance mutations., Results: Out of 248 strains, 153 (61.7%) harboured > or =1 ETV resistance mutations. In particular, 88 (35.5%), 53 (21.4%) and 12 (4.8%) harboured one, two and three mutations, respectively. The most frequent mutations were G190A (230%), Y181C (23%) and K101E (14.1%). Use of nevirapine (odds ratio [OR] 2.73; 95% confidence level [CI] 1.62-4.62; P<0.001) and a longer time frame between first HIV RNA >500 copies/ml and GRT (per month, OR 1.05; 95% CI 1.01-1.09; P=0.012) were associated with a greater number of ETV resistance mutations. Conversely, higher CD4+ T-cell counts at nadir (per 100 cells/mm3, OR 0.81; 95% CI 0.67-0.98; P=0.029) and use of lamivudine/emtricitabine (OR 0.57; 95% CI 0.37-0.87; P=0.009) were protective. Accumulation of ETV resistance-associated mutations was demonstrated by sequential GRT in 4/35 patients (all treated with nevirapine)., Conclusions: Mutations associated with ETW resistance were common among patients failing on NNRTI, but prevalence of viral strains harbouring three mutations was low. Use of efavirenz and co-administration of lamivudine reduced the risk of ETW resistance. The continued use of the current NNRTI in a failing regimen may select for additional resistant variants.

Published
2008

4. Prevalence and Risk Factors for Etravirine Resistance among Patients Failing on Non-Nucleoside Reverse Transcriptase Inhibitors

Author

Giampiero Carosi, Silvia Costarelli, Alessandra Calabresi, Carlo Torti, Nino Manca, Eugenia Quiros-Roldan, Filippo Castelnuovo, Giuseppe Lapadula, Giuseppe Paraninfo, Francesca Ceresoli, Franco Gargiulo, Lapadula, G, Calabresi, A, Castelnuovo, F, Costarelli, S, Quiros-Roldan, E, Paraninfo, G, Ceresoli, F, Gargiulo, F, Manca, N, Carosi, G, and Torti, C

Subjects
Adult, Male, Anti-HIV Agents, Etravirine, HIV Infections, Microbial Sensitivity Tests, Drug resistance, Treatment failure, Nucleoside Reverse Transcriptase Inhibitor, Viral genetics, Risk Factors, Drug Resistance, Viral, Nitriles, Prevalence, medicine, Humans, Pharmacology (medical), Nevirapine, Treatment Failure, Risk factor, Etravirine, NNRTI, drug resistance mutations, Pharmacology, Reverse-transcriptase inhibitor, business.industry, Virology, Reverse transcriptase, CD4 Lymphocyte Count, Pyridazines, Logistic Models, Pyrimidines, Infectious Diseases, Italy, Mutation, HIV-1, RNA, Viral, Reverse Transcriptase Inhibitors, Female, business, medicine.drug
Abstract

Background Prevalence and factors associated with etravirine (ETV) resistance mutations among patients failing on first-generation non-nucleoside reverse transcriptase inhibitors (NNRTI) merit investigation. Methods The study comprised an analysis of all sequential patients attending the Institute of Infectious Diseases (Brescia, northern Italy) who performed a genotypic resistance testing (GRT) after ≥3 months of a stable NNRTI-based regimen between 2001 and 2006. Multivariable ordinal logistic regression analysis was performed to assess predictors of ETV resistance mutations. Results Out of 248 strains, 153 (61.7%) harboured ≥1 ETV resistance mutations. In particular, 88 (35.5%), 53 (21.4%) and 12 (4.8%) harboured one, two and three mutations, respectively. The most frequent mutations were G190A (23%), Y181C (23%) and K101E (14.1%). Use of nevirapine (odds ratio [OR] 2.73; 95% confidence level [CI] 1.62–4.62; P500 copies/ml and GRT (per month, OR 1.05; 95% CI 1.01–1.09; P=0.012) were associated with a greater number of ETV resistance mutations. Conversely, higher CD4+ T-cell counts at nadir (per 100 cells/mm3, OR 0.81; 95% CI 0.67–0.98; P=0.029) and use of lamivudine/emtricitabine (OR 0.57; 95% CI 0.37–0.87; P=0.009) were protective. Accumulation of ETV resistance-associated mutations was demonstrated by sequential GRT in 4/35 patients (all treated with nevirapine). Conclusions Mutations associated with ETV resistance were common among patients failing on NNRTI, but prevalence of viral strains harbouring three mutations was low. Use of efavirenz and co-administration of lamivudine reduced the risk of ETV resistance. The continued use of the current NNRTI in a failing regimen may select for additional resistant variants.

Published
2008

5. Updated prevalence of genotypic resistance among HIV-1 positive patients naïve to antiretroviral therapy: a single center analysis

Author

Giampiero Carosi, Francesca Ceresoli, Giuseppe Lapadula, Carlo Torti, Giuliana Cologni, Franco Gargiulo, Nino Manca, Ilaria Izzo, Filippo Castelnuovo, Giuseppe Paraninfo, Eugenia Quiros-Roldan, Lapadula, G, Izzo, I, Gargiulo, F, Paraninfo, G, Castelnuovo, F, Quiros-Roldan, E, Cologni, G, Ceresoli, F, Manca, N, Carosi, G, and Torti, C

Subjects
Adult, Male, medicine.medical_specialty, Genes, Viral, Etravirine, HIV Infections, Acquired immunodeficiency syndrome (AIDS), Virology, Drug Resistance, Viral, Epidemiology, medicine, Humans, Resistance mutation, HIV Infection, Sida, Darunavir, biology, business.industry, HIV, Naïve, Middle Aged, medicine.disease, biology.organism_classification, Antiretroviral therapy, Infectious Diseases, Amino Acid Substitution, Italy, Mutation, Lentivirus, HIV-1, RNA, Viral, Female, Viral disease, business, Tipranavir, Human, medicine.drug
Abstract

Continuous surveillance of HIV primary resistance mutations is highly important due to their potential clinical impact. All patients naive to antiretrovirals who had ≥1 genotypic resistance testing at the Institute of Infectious Diseases (Brescia, Northern Italy) between 2001 and 2006 were analyzed. Primary resistance mutations were defined using epidemiological and clinical criteria. Mutations were interpreted using the Stanford University Algorithm. Logistic regression analysis was used to assess possible predictors of primary resistance mutations. Among 569 patients, 11% presented ≥1 mutation. Prevalence of primary resistance mutations to nucleoside reverse-transcriptase inhibitors (NRTI), non-nucleoside reverse-transcriptase inhibitors (NNRTI), and protease inhibitors (PI) was 6.3%, 6%, and 1.6%, respectively. The most frequent mutations to NRTI were substitutions at position 215 (215Y in 3 patients, and 215 revertants in 16), 41L (13), 219Q (12), and 210W (10). Among mutations to NNRTI, 103N was found in 21 patients, while 181C, 188L, and 190A/S in 8, 3, and 4 patients, respectively. Fifty-one patients (9%) had high-to-intermediate resistance to ≥1 antiretroviral drug before starting the treatment. Regarding the new generation drugs, nine patients had intermediate resistance to etravirine, five patients had intermediate resistance to tipranavir, while five, one, and seven patients had low resistance to etravirine, tipranavir, and darunavir. Homosexuals were more likely to harbor a virus with primary resistance mutations (OR:2.68; 95% CI:1.44-5.00; P=0.002) while non-Italian nationality was protective (OR:0.38; 95% CI:0.17-0.86; P=0.020). Prevalence of primary resistance mutations suggests that genotypic resistance testing should be performed before starting treatment in naïve patients in Italy, particularly when NNRTI are prescribed. © 2008 Wiley-Liss, Inc.

Published
2008

6. Plasma HIV load and proviral DNA decreases after two standard antiretroviral regimens in HIV-positive patients naïve to antiretrovirals

Author

Giuseppe Lapadula, Michele Nichelatti, Andrea Cossarizza, Maria Eugenia Quiros-Roldan, Milena Nasi, Nino Manca, Giuliana Cologni, Silvia Costarelli, Franco Gargiulo, Carlo Torti, Francesca Ceresoli, Giampiero Carosi, Michele Magoni, Marcello Pinti, Torti, C, Quiros-Roldan, M, Cologni, G, Nichelatti, M, Ceresoli, F, Pinti, M, Nasi, M, Cossarizza, A, Lapadula, G, Costarelli, S, Manca, N, Gargiulo, F, Magoni, M, and Carosi, G

Subjects
CD4-Positive T-Lymphocytes, Cyclopropanes, Male, HAART, HIV Infections, Gastroenterology, law.invention, chemistry.chemical_compound, Randomized controlled trial, law, Antiretroviral Therapy, Highly Active, Organophosphonate, Medicine, HIV Infection, Alkyne, Plasma viral load, virus diseases, Lamivudine, Lopinavir, Cyclopropane, Middle Aged, Viral Load, Antiretroviral therapy, Reverse Transcriptase Inhibitor, Infectious Diseases, HIV, Treatment Outcome, CD4-Positive T-Lymphocyte, Alkynes, Reverse Transcriptase Inhibitors, Boosted protease inhibitors, Non nucleoside reverse transcriptase inhibitors, Proviral HIV-DNA, Female, Viral load, medicine.drug, Human, Adult, Benzoxazine, medicine.medical_specialty, Efavirenz, Boosted protease inhibitor, Organophosphonates, Non nucleoside reverse transcriptase inhibitor, Drug Administration Schedule, Zidovudine, Virology, Internal medicine, Humans, Tenofovir, Surrogate endpoint, business.industry, Adenine, Biomarker, Benzoxazines, CD4 Lymphocyte Count, chemistry, Immunology, DNA, Viral, HIV-1, Ritonavir, business, Biomarkers
Abstract

(i) To compare early decrease of HIV plasma viral load (pVL) after two standard-combinations of highly active antiretroviral therapy (HAART) (ii) To evaluate variations of proviral HIV-DNA load on conditions of sustained pVL undetectability. Two different sub-studies of a multicentre prospective randomized controlled trial which compared two first-line HAART (i.e., zidovudine+lamivudine+lopinavir/ritonavir versus tenofovir+lamivudine+ efavirenz). Only patients enrolled at the coordinating centre (University of Brescia) were included in the two sub-studies. In the first sub-study, we calculated pVL decrease with respect to baseline at any of the following time-point: days 1, 3, 7, 14 and 28. Decreases of the pVL were compared between the two treatment groups. In the second sub-study, we'analyzed, variation of proviral HIV-DNA load in CD4+ T-cells from baseline to week 52 only in patients who maintained the same treatment regimen and had sustained undetectable pVL. In either studies, linear regression analysis was used to investigate what factors could influence variations of pVL and of proviral HIV-DNA load. (i) 64 patients were studied. A significant decrease of pVL was found from day 3 on, without statistically significant differences between the two study groups. However, after adjusting for possible confounders, tenofovir+lamivudine+efavirenz resulted to be associated with greater pVL decreases. (ii) 45 patients were studied. Mean proviral HIV-DNA load decreased from 1,610 (95%CI: 879-2,341) to 896 (95% CI 499-1,293) copies/106 cells (P=0.05). Linear regression analysis showed that the decrease of proviral DNA load during follow-up was independently and inversely correlated with age. Further studies are needed to compare pVL decay between antiretroviral regimens and assess whether proviral HIV-DNA load is a surrogate marker of treatment effectiveness. © 2008 Bentham Science Publishers Ltd.

Published
2008

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