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Pesquisa : G06.225.420 [Categoria DeCS]
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Id: biblio-1052891
Autor: Benso, José; Ciapponi, Agustín.
Título: Uso de anillo vaginal con dapivirina para prevención de infección por HIV en mujeres / Use of a vaginal ring containing dapivirine for HIV prevention in women
Fonte: Evid. actual. práct. ambul;22(4):e001067, 2019.
Idioma: es.
Descritores: Pirimidinas/administração & dosagem
Infecções por HIV/prevenção & controle
HIV-1
Inibidores da Transcriptase Reversa/administração & dosagem
-Pirimidinas/efeitos adversos
Vagina
Infecções por HIV/epidemiologia
Método Duplo-Cego
Estudos Multicêntricos como Assunto
Fatores Etários
Cooperação do Paciente
Ensaios Clínicos Fase III como Assunto
Inibidores da Transcriptase Reversa/efeitos adversos
África Austral/epidemiologia
Farmacorresistência Viral
Ensaios Clínicos Controlados não Aleatórios como Assunto
Limites: Seres Humanos
Masculino
Feminino
Adolescente
Adulto
Meia-Idade
Adulto Jovem
Tipo de Publ: Comentário
Responsável: AR2.1 - Biblioteca Central


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Id: biblio-1025198
Autor: Guaragna, Graciela; Casiró, Arnaldo; Montero, Antonio.
Título: El acceso universal al tratamiento antirretroviral no ha modificado las causas de internación y muerte en infectados por HIV en Buenos Aires / The universal high active antiretroviral treatment (HAART) did not chance the causes of admiission and death of HIV infected patients in Buenos Aires
Fonte: Prensa méd. argent;105(3):99-105, may 2019. tab.
Idioma: es.
Resumo: Introducción: El tratamiento antirretroviral de alta eficacia (TARGA) ha desplazado a las infecciones oportunistas como principal causa de hospitalización en infectados por el HIV. Sin embargo, algunos autores hallaron que las causas de internación por HIV en Buenos Aires no cambiaron a pesar del acceso universal al TARGA desde 1996. Pacientes y Métodos. Para confirmar estos resultados revisamos todos los ingresos hospitalarios ocurridos durante tres años en un hospital general de la ciudad de Buenos Aires. Resultados: 57 pacientes (34 hombres) tuvieron 79 hospitalizaciones: 43 ingresaron sólo una vez y los 14 restantes tuvieron dos o más ingresos hasta totalizar 36 internaciones. La edad fue de 44.46 ± 11.55 años (promedio ± desvío estándard), 43 pacientes (75.45%) se sabían HIV + y 28 de ellos (65.12%) recibían TARGA al ingreso, 31 hospitalizaciones (39.24%) fueron causadas por enfermedades marcadoras de SIDA; 35 (44.30%) por infecciones no marcadoras de SIDA (INMS) y 13 (13.46%) por enfermedades no infecciosas. Tuberculosis fue el diagnóstico más frecuente (11 casos, 13.92%), seguida por meningitis a Cryptococcus neoformans en 9 (11.39%) y toxoplasmosis cerebral en 6 (7.59%). Entre las INMS, la neumonía fue la principal causa de hospitalización (13 pacientes, 16.46%). Discusión: Estos resultados confirman resultados previos comunicando que las causas de hospitalización en infectados por el HIV no cambiaron en respuesta al TARGA en Buenos Aires, lo que puede estar reflejando problemas de detección o adherencia, o puede estar relacionado con resistencia viral, razones sociales o cualquier combinación de estos factores (AU)

Introduction. High Active Antiretroviral Treatment (HAART) displaced opportunistic infections as the main cause of hospitalization in HIV infected patients. However, some authors found that causes for hospitalization in HiV infected patients did not changed at Buenos Aires although this country offers universal access to HAART since 1996. Patients and Methods. We analyzed all the HIV related admissions recorded during three years at a general hospital. Results. 57 patients (34 men) were hospitalized 79 times. 43 out of them were hospitalized only one time. The reaining 14 were hospitalized 36 times. Age was 44.46 ± 11.55 years (mean ± standard deviation). 43 patients (75.45%) had a previous diagnosis of HIV infection. 28 of them (65.12%) received HAART. 31 hospitalizations (39.24%) were caused by AIDS defining events. 35 (44.30%) related to non-AIDS-defining infections diseases (NADID), and 13 (13.46%) to non-infections diseases. Tuberculosis was the prevalent illness (11 cases, 13.92%), followed by cryptoccal meningitis in 9 (11.39%) and cerebral toxoplasmosis in 6 (7.59%). Among NADID, pneumonia was the main cause of admission (13 patientes, 16,46%). Discussion: These results confirm previous reports showing that causes of HIV related hospitalization remain unchanged in spite of HAART at Buenos Aires, which may be reflecting problems of detection and adherence, or may be related to local viral resistance, social reasons, or any combination of these factors (AU)
Descritores: Doenças Transmissíveis/diagnóstico
Análise Estatística
Estudos Retrospectivos
HIV/imunologia
Terapia Antirretroviral de Alta Atividade/estatística & dados numéricos
Farmacorresistência Viral/imunologia
Doenças não Transmissíveis
Pacientes Internados/estatística & dados numéricos
Limites: Seres Humanos
Adulto
Meia-Idade
Tipo de Publ: Estudo Observacional
Responsável: AR392.1 - Biblioteca


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Id: biblio-1022184
Autor: Cavalcanti, J de S; Ferreira, J L; Guimarães, P M; Vidal, J E; Brigido, L F.
Título: High frequency of dolutegravir resistance in patients failing a raltegravir-containing salvage regimen
Fonte: J Antimicrob Chemother;70(3):926-929, 2015.
Idioma: en.
Resumo: OBJECTIVES: Dolutegravir is a second-generation integrase strand transfer inhibitor (InSTI) that has been recently approved by the FDA to treat antiretroviral therapy-naive as well as treatment-experienced HIV-infected individuals, including those already exposed to the first-generation InSTI. Despite having a different mutational profile, some cross-resistance mutations may influence its susceptibility. The aim of this study was to evaluate the impact of a raltegravir-containing salvage regimen on dolutegravir activity. PATIENTS AND METHODS: Blood samples of 92 HIV-infected individuals with virological failure (two or more viral loads >50 copies/mL after 6 months of treatment) using raltegravir with optimized background therapy were sequenced and evaluated according to the Stanford University HIV Drug Resistance Database algorithm. RESULTS: Among the 92 patients analysed, 32 (35%) showed resistance to dolutegravir, in most cases associated with the combination of Q148H/R/K with G140S/A mutations. At genotyping, patients with resistance to dolutegravir had viral load values closer to the highest previously documented viral load. CONCLUSIONS: Changes in viraemia during virological failure may indicate the evolution of raltegravir resistance and may predict the emergence of secondary mutations that are associated with a decrease in dolutegravir susceptibility. Early discontinuation of raltegravir from failing regimens might favour subsequent salvage with dolutegravir, but further studies are necessary to evaluate this issue.
Descritores: Pirrolidinonas/uso terapêutico
Seres Humanos
Infecções por HIV/tratamento farmacológico
HIV-1/efeitos dos fármacos
HIV-1/genética
Terapia de Salvação/métodos
Falha de Tratamento
Análise de Sequência de DNA
Fármacos Anti-HIV/uso terapêutico
Fármacos Anti-HIV/farmacologia
Adulto
Mutação de Sentido Incorreto
Farmacorresistência Viral
Adulto Jovem
Raltegravir Potássico
Genótipo
Compostos Heterocíclicos/farmacologia
Meia-Idade
Responsável: BR91.2 - Centro de Documentação


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Texto completo SciELO Brasil
Texto completo
Id: biblio-841806
Autor: Amaral, Amanda GM; Oliveira, Isabele B; Carneiro, Diego C; Alcantara, Luiz CJ; Monteiro-Cunha, Joana P.
Título: An overview of the molecular and epidemiological features of HIV-1 infection in two major cities of Bahia state, Brazil
Fonte: Mem. Inst. Oswaldo Cruz;112(6):411-418, June 2017. tab, graf.
Idioma: en.
Resumo: BACKGROUND The high mutation rate of the human immunodeficiency virus (HIV) has created a public health challenge because the use of antiretroviral drugs can generate selective pressure that drives resistance in these viruses. OBJECTIVE The aim of this work was to characterise the molecular and epidemiological profile of HIV in Bahia, Brazil. METHODS DNA sequences from regions of HIV gag, pol, and env genes were obtained from previous studies performed in this area between 2002 and 2012. Their genotype and drug-resistance mutations were identified using bioinformatics tools. Clinical and epidemiological data were analysed. FINDINGS Among 263 individuals (46.4% male), 97.5% were asymptomatic and 49.1% were receiving treatment. Most of the individuals were 31 to 40 years old (36.9%) and infected through heterosexual contact (40.7%). The predominant genotype was B (68.1%) followed by BF recombinants (18.6%). Among the individuals infected with either F or BF genotypes, 68.4% were women and 76.8% were infected through heterosexual transmission. The prevalence of associated mutations conferring antiretroviral resistance was 14.2%, with 3.8% of all mutations conferring resistance to protease inhibitors, 9.43% to nucleoside reverse transcriptase inhibitors, and 8.5% to non-nucleoside reverse transcriptase inhibitors. Drug resistance was higher in individuals receiving treatment (26.1%) than in the drug-naïve (4.3%) individuals. MAIN CONCLUSIONS This study will contribute to the understanding and monitoring of HIV epidemic in this Brazilian region.
Descritores: Infecções por HIV/genética
Infecções por HIV/virologia
HIV-1/imunologia
Análise de Sequência de DNA
Farmacorresistência Viral/genética
-Brasil/epidemiologia
Fatores de Risco
HIV-1
Mutação/genética
Limites: Seres Humanos
Masculino
Feminino
Adolescente
Adulto
Meia-Idade
Idoso
Responsável: BR1.1 - BIREME


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Texto completo SciELO Cuba
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Id: lil-735342
Autor: Díaz Torres, Héctor Manuel; Machado Zaldívar, Liuber Yans; Martínez Fernández, Liodelvio; Ruiz Gutiérrez, Nancy María; Nibot Sánchez, Carmen; Valdés de Calzadilla, Neisy; Dubed Echevarría, Marta; Blanco de Armas, Madeline.
Título: Comportamiento de la resistencia a drogas antirretrovirales en una consulta externa de La Habana durante el año 2012 / Resistance behavior to antiretroviral drugs in a havana outpatient consultation in 2012
Fonte: Rev. cuba. med;53(4):445-455, sep.-dic. 2014.
Idioma: es.
Resumo: INTRODUCCIÓN: la emergencia de virus de inmunodeficiencia humana tipo 1 (VIH-1) resistentes a antirretrovirales constituye una de las principales causas de fallo terapéutico. OBJETIVO: analizar las mutaciones asociadas a resistencia a los antirretrovirales y los niveles de resistencia en un grupo de pacientes con criterios de fallo a la terapia antirretroviral de gran actividad (TARGA) durante el año 2012.MÉTODOS: se colectaron muestras de plasma de 25 individuos con criterios de fallo a la TARGA, de los 157 pacientes positivos al VIH-1 que asistieron a la Consulta Externa de Infectología del Hospital "Hermanos Ameijeiras" durante el año 2012. Se determinó el subtipo viral y las mutaciones asociadas a resistencia y se estimó el tiempo transcurrido entre el inicio de la última terapia y la detección de virus resistente. RESULTADOS: 52 % de los pacientes solamente había recibido un régimen de TARGA. Se detectaron mutaciones asociadas a resistencia en 84 % de los pacientes. El 64 % presentó alta resistencia a los antirretrovirales empleados como primera estrategia terapéutica en el país. El tiempo promedio entre el inicio de la última terapia y la detección de virus resistente fue de 2,3 años. El 16 % de los pacientes presentó virus susceptibles, en este grupo la probabilidad de no adherencia a la TARGA pudo ser la causa del fallo terapéutico. CONCLUSIONES: se evidenciaron altos niveles de resistencia a la primera línea de TARGA empleada en Cuba y la aparición de variantes resistentes después de iniciar el tratamiento. Estos resultados enfatizan la necesidad del monitoreo de la resistencia como parte de la atención integral a las personas que viven con VIH/Sida.

INTRODUCTION: the emergence of resistant virus antiretroviral human immunodeficiency type 1 (HIV-1) is a major cause of treatment failure. OBJECTIVE: to analyze the mutations associated with antiretroviral resistance and resistance levels in a group of patients with failure criteria to antiretroviral therapy (HAART). METHODS: Plasma samples from 25 individuals with failure criteria to HAART were collected out of 157 HIV-1 positive patients attending the Outpatient Infectious Diseases at Hermanos Ameijeiras Hospital during 2012. The viral subtype and resistance mutations were determined; and the time between the beginning of the last therapy and detection of resistant viruses was estimated time. RESULTS: 52 % of patients had only received HAART regimen. Mutations associated with resistance in 84 % of patients were detected. 64 % had to antiretroviral treatment strategy employed as first high resistance in this country. The average time between the beginning of the last therapy and the detection of resistant viruses was 2.3 years. 16 % of patients had susceptible virus. The probability of non-adherence to HAART could be the cause of therapeutic failure in this group. CONCLUSIONS: high levels of resistance to first-line HAART used in Cuba and the emergence of resistant variants after starting treatment were evident. These results emphasize the need for monitoring resistance as part of comprehensive care for people living with HIV / AIDS.
Descritores: HIV-1/efeitos dos fármacos
Fármacos Anti-HIV/uso terapêutico
Farmacorresistência Viral
Antirretrovirais/uso terapêutico
-Cuba
Limites: Seres Humanos
Responsável: CU1.1 - Biblioteca Médica Nacional


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Id: biblio-971945
Autor: Mello, Leda Maria Simões.
Título: Caracterização da resistência transmitida e variabilidade genética do HIV-1 em pacientes recém-diagnosticados no centro de testagem e aconselhamento de Fortaleza.
Fonte: Fortaleza; s.n; 2016. 105 p. ilus, tab.
Idioma: pt.
Tese: Apresentada a Universidade Federal do Ceará para obtenção do grau de Mestre.
Resumo: A terapia antirretroviraltemporobjetivodiminuiramorbidadeemortalidadedaspessoascomHIV/AIDS,melhorandoaqualidadeeaexpectativadevida. Paradoxalmente, o tratamento irregular pode favorecer a seleçãode variantes resistentes, representandouma das principais causas de falha terapêutica. Tais cepas resistentes podem ser transmitidas a outros indivíduos(resistência transmitida), predispondo àfalha precoce do tratamento inaugural. Ostestesderesistência,principalmenteagenotipagem,permitemadetecçãodemutaçõesdogenomaviral.OobjetivodesteestudofoicaracterizarasmutaçõesderesistênciatransmitidadoHIV-1aosantirretroviraisempacientesrecém-diagnosticadosnoCentro de Testagem e Aconselhamento (CTA) de Fortaleza.Duranteoperíododeoutubrode2013asetembrode2014,foramrecrutadospacientescomtestereagente para oHIVrealizadono CTA. Foram colhidas amostras para realizaçãode quantificação da cargaviral(AbbottRealTime),contagemdelinfócitos CD4+(FACSCaliburBD)egenotipagemHIV-1(TruGeneSiemens).As sequências genéticasforam alinhadas pelo programa MEGA eBioEdit. Ossubtipos do vírus HIV-1 foram determinados e identificados empregando análises no banco de dados do REGA HIV Subtyping Tool. A análisedas mutações de resistência aos antirretrovirais foi realizada utilizando o algoritmo da Universidade de Stanford(HIVdbProgram)e as mutaçõesderesistênciatransmitidaforamidentificadasempregandoaCalibraçãodeResistênciaPopulacional.Foram obtidas amostras biológicas de 108 pacientes, sendo que em 105delas foi possível realizar a reação de sequenciamentoea avaliação quantoàpresençademutaçõesderesistênciaassociadasaos antirretrovirais...

Antiretroviral therapy aims to reduce morbidity and mortality of people with HIV / AIDS, improving the quality and life expectancy. Paradoxically, the irregular treatment may favor the selection of resistant variants, representing a major cause of treatment failure. Such resistant strains can be transmitted to other individuals (transmitted resistance) predisposing to early failure of the inaugural treatment. Resistance tests, particularly genotyping, allow mutation detection in the viral genome. Theaim of this study was to characterize the transmitted resistance HIV-1 mutations to antiretroviral drugs in newly diagnosed patients in the Counseling and Testing Center (CTC) in Fortaleza. During the period October 2013 to September 2014, patients with reagent test for HIV were recruited at CTC. Samples for viral load quantitation (Abbott RealTime), CD4 lymphocytes count (BD FACSCalibur) and HIV-1 genotyping (TRUGENE Siemens), were collected. Genetic sequences were aligned by MEGA and BioEdit program. Thesubtypes of HIV-1 were determined and identified using analysis in REGA HIV subtyping Tool database. The analysis of the antiretroviral resistance mutation was performed using the algorithm of Stanford University (HIVdb Program) and transmitted mutation resistance was identified using the CalibratedPopulationResistance (CPR). Biological samples were obtained from 108 patients, among which in 105 was possible to perform the sequencing reaction and evaluation for the presence of mutations to conferantiretroviral drugresistance...
Descritores: Terapia Antirretroviral de Alta Atividade
Farmacorresistência Viral
Mutação
Variação Genética
Limites: Seres Humanos
Responsável: BR6.1 - BCS - Biblioteca de Ciências da Saúde
BR6.1


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Id: biblio-834305
Autor: Samayoa, Blanca; Universidad de San Carlos de Guatemala; Medina, Narda; Arathoon, Eduardo; Lau-Bonilla, Dalia; Moller, Anneliese.
Título: Evaluación de resistencia genotípica del VIH-1 en pacientes con fallo virológico de Guatemala / Evaluation of genotypic resistance of HIV-1 in patients with virologic failure Guatemala
Fonte: Cienc. tecnol. salud;1(1):5-12, jul.-dic. 2014. ilus, graf.
Idioma: es.
Resumo: La resistencia a la terapia antirretroviral (TARV) es un factor determinante para el fallo virológico en pacientes con VIH. El objetivo de este estudio fue identificar los patrones genotípicos de resistencia en pacientes con fallo virológico. Fueron incluidos pacientes de las diferentes unidades de atención integral de VIH en Guatemala, de quienes se sospechaba resistencia y que necesitaban cambios en la TARV por fallo virológico, se requirió haber evaluado la adherencia y una carga viral ≥1,000 copias/ml. La información clínica y demográfica fue recolectada a través de la forma de solicitud. El análisis de resistencia se realizó a través de la metodología TRUGENE® HIV-1. La muestra se restringió a 25 pacientes por motivos de accesibilidad. El 68% de las muestras analizadas presentaron resistencia; por familia de ARV la resistencia fue de 88.2% para ITINN, 70.5% para ITIAN y 17.6% para IP. Se identificaron 79 mutaciones entre el grupo de estudio, el 46.8% de fueron asociadas a ITINN, 76.6% a ITIAN y 26.6% a IP. Para ITIAN las mutaciones más frecuentes fueron la M184V 43%, M184I 14% y K219E 10%; el 23.8% fueron mutaciones TAMs. Para ITINN fueron la V179D 16%, K103N 14%, G190A 14% y Y181C 14%. Para los IP la mutación más frecuente fue la M36I con 29%. La resistencia identificada en este grupo, fue menor a lo reportado en otros países latinoamericanos; sin embargo es similar a lo reportado por OMS en países con bajo o medio ingreso económico.

ARV drug resistance is one of the leading causes of virologic failure among HIV patients on HAART. Theobjective of this study was to determine genotypic resistance profiles among HIV patients on virologic failure. Patients from one HIV clinic in Guatemala on whom ARV drug resistance was suspected and needed a change in their ARV regimen due to virologic failure were included. In order to perform the genotype, the patient had to demonstrate good adherence to therapy and a confirmed viral load ≥1,000 copies/ml. Demographics andclinical data were collected through the resistance-testing questionnaire. The TRUGENE® HIV-1 methodology was used for resistance analysis. The patient sample was restricted to 25 patients due to accessibility, 68% presented resistance to at least one ARV drug. By ARV class, 88.2% presented resistance to NNRTIs, 70.5% to NRTIs and 17.6% to IPs. We found 79 mutations among the samples analyzed. Of the mutations found, 46.8% were associated with NNRTI resistance, 76.6% to NRTI resistance and the remainder 26.6% to PI resistance. The most frequent NRTI associated mutations were M184V 43%, M184I 14% and K219E 10%; 23.8% were TAM. The NNRTI associated mutations were V179D 16%, K103N 14%, G190A 14% and Y181C 14%. For the PI the most frequent mutation was M36I with 29%. The resistance found in this study was lower to that reported in other Latin American studies, however, it is similar to what is reported by WHO in low and middle income countries.
Descritores: Farmacorresistência Viral
HIV-1
-Antirretrovirais/imunologia
Mutação
Limites: Seres Humanos
Masculino
Feminino
Tipo de Publ: Estudo Comparativo
Responsável: GT49.1


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Id: lil-780404
Autor: Mesplède, Thibault; Raffi, Francois; Wainberg, Mark A.
Título: ¿Es posible que se genere resistencia al dolutegravir cuando se utiliza este agente en el tratamiento de primera línea? / Is resistance to Dolutegravirpossible when this drug is used in first-line therapy?
Fonte: Actual. SIDA. infectol;22(85):47-52, set.2014. ilus.
Idioma: es.
Resumo: Dolutegravir (DTG) es un inhibidor de la integrasa del VIH aprobado recientemente como tratamiento por la FDA (Food and Drug Administration) en los Estados Unidos. Utilizado como parte de un tratamiento de primera línea, DTG es el único tratamiento antirretroviral frente al cual no se ha seleccionado resistencia en la clínica. Nuestra teoría es que esto se debe al prolongado tiempo de unión del DTG a la enzima integrasa así como a una capacidad de replicación muy disminuida por parte de los virus que podrían volverse resistentes al DTG. Además, conjeturamos que DTG podría ser utilizado en estrategias que apunten a la erradicación del VIH...

Dolutegravir (DTG) is an HIV integrase inhibitor that was recently approved for therapy by the Food and Drug Administration in the United States. When used as part of First-line therapy, DTG is the only HIV drug that has not selected for resistance mutations in the clinic. We believe that this is due to the long binding time of DTG to the integrase enzyme as well as greatly diminished replication capacity on the parte of viruses that might become resistant to DTG. We further speculatethat DTG might be able to be used in strategies aimed at HIV eradication...
Descritores: Terapia Antirretroviral de Alta Atividade
Farmacorresistência Viral
Inibidores da Protease de HIV/farmacologia
Integrase de HIV/uso terapêutico
Mutação
Limites: Seres Humanos
Tipo de Publ: Carta
Responsável: AR392.1 - Biblioteca


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Id: lil-757098
Autor: Cecchini, Diego; Castillo, Sonia; Vecchio, Claudia; Sandoval, Carolina; Cabral, Leticia; Rodríguez Iantorno, Paula; Cassetti, Isabel.
Título: Resistencia primaria de HIV en el área metropolitana de Buenos Aires
Fonte: Medicina (B.Aires);75(3):163-168, June 2015. tab.
Idioma: es.
Resumo: La vigilancia de resistencia primaria de HIV es fundamental para optimizar el tratamiento antirretroviral (TARV) de la infección. Las mutaciones a vigilar están definidas en una lista de referencia de la Organización Mundial de la Salud (OMS), que no incluye mutaciones para drogas nuevas como la rilpivirina. Revisamos retrospectivamente las historias clínicas de pacientes naive de TARV asistidos en 2011-2013 en un centro privado de derivación de HIV/Sida, pesquisando mutaciones según criterios de OMS y mutaciones específicas de resistencia a rilpivirina. Incluimos 91 pacientes; 71 (78.0%) eran hombres y 46 (50.5%) eran hombres que tenían sexo con hombres; 34 (37.4%) presentaban infección temprana y 60 (65.9%) estaban asintomáticos. Los valores medianos de edad, carga viral y recuento de CD4 fueron 33 años, 62 100 copias/ml y 548 células/μl, respectivamente. Encontramos mutaciones de lista OMS en 11 (12.1%) pacientes, dos de ellos presentaron mutaciones a dos familias de drogas. Siete mutaciones correspondieron a inhibidores no nucleosídicos de la retrotranscriptasa, cuatro a análogos nucleosídicos y dos a inhibidores de la proteasa; las más frecuentes fueron K103N y M41L. No hubo mayor frecuencia de mutaciones en pacientes con infección temprana, ni diferencias según sexo, orientación sexual o recuento de CD4. Tres pacientes (3.3%) presentaron mutaciones asociadas a bajos niveles de resistencia a rilpivirina (E138A, E138G). Los niveles de resistencia primaria observados en este estudio evidencian la importancia de determinar resistencia previo al inicio de TARV en la población asistida en nuestro centro. La prevalencia observada de resistencia primaria a rilpivirina fue baja.

Surveillance of primary drug resistance is critical to optimize antiretroviral therapy (ART) for HIV. Mutations to be monitored are defined in a reference list of the World Health Organization (WHO), which does not include mutations for new drugs, such as rilpivirine. We undertook a retrospective analysis of medical records of ART naive patients treated at a specialized HIV/AIDS center, evaluating the prevalence of WHO mutations and mutations specific for rilpivirine. Ninety-one patients were included during 2011-2013, being male 71 (78.0%), and men who have sex with men 46 (50.5%). The median values for age, viral load, and CD4 counts were 33 years, 62 100 copies/mL, and 548 cells/l, retrospectively; 34 (37.3%) had early infection and 60 (65.9%) were asymptomatic. WHO mutations were found in 11 (12.1%) patients, two of whom presented multiple mutations. Seven mutations corresponded to non-nucleoside reverse transcriptase inhibitors, four to nucleoside analogues, and two to protease inhibitors. The most frequent mutations were K103N and M41L. No differences in mutation frequencies were found when compared by time post-infection, gender, sexual orientation, or CD4 count. Mutations conferring low-level resistance to rilpivirine were found in 3 (3.3%) patients; such mutations were E138A and E138G. The overall moderate primary resistance levels found in this study highlight the value of performing a resistance test before ART initiation in the served population. The observed prevalence of primary resistance to rilpivirine was low.
Descritores: Fármacos Anti-HIV
Farmacorresistência Viral/genética
Infecções por HIV/virologia
HIV-1
Mutação
-CDABBREVIATIONS AS TOPIC LYMPHOCYTE COUNT
HIV-1
Prevalência
Estudos Retrospectivos
População Urbana
Carga Viral
Limites: Adulto
Feminino
Seres Humanos
Masculino
Responsável: AR1.2 - Instituto de Investigaciónes Epidemiológicas


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Id: lil-756404
Autor: Slavov, SN; Vilar, FC; Wagatsuma, VMD; Santana, RC; Machado, AA; Fonseca, BAL da; Kashima, S; Covas, DT.
Título: Late emergence of A594V and L595W mutations related to ganciclovir resistance in a patient with HCMV retinitis and long-term HIV progression
Fonte: Braz. j. med. biol. res = Rev. bras. pesqui. méd. biol;48(9):777-781, Sept. 2015. ilus.
Idioma: en.
Projeto: FAPESP; . CNPq.
Resumo: The emergence of ganciclovir (GCV) resistance during the treatment of human cytomegalovirus (HCMV) infection is a serious clinical challenge, and is associated with high morbidity and mortality. In this case report, we describe the emergence of two consecutive mutations (A594V and L595W) related to GCV resistance in a patient with HCMV retinitis and long-term HIV progression after approximately 240 days of GCV use. Following the diagnosis of retinitis, the introduction of GCV did not result in viral load reduction. The detected mutations appeared late in the treatment, and we propose that other factors (high initial HCMV load, previous GCV exposure, low CD4+ cell count), in addition to the presence of resistance mutations, may have contributed to the treatment failure of HCMV infection in this patient.
Descritores: Infecções Oportunistas Relacionadas com a AIDS/genética
Antivirais/uso terapêutico
Retinite por Citomegalovirus/genética
Farmacorresistência Viral/genética
Ganciclovir/uso terapêutico
Mutação
-Infecções Oportunistas Relacionadas com a AIDS/tratamento farmacológico
Infecções Oportunistas Relacionadas com a AIDS/virologia
Retinite por Citomegalovirus/tratamento farmacológico
Progressão da Doença
DNA Viral/genética
Falha de Tratamento
Carga Viral/efeitos dos fármacos
Limites: Seres Humanos
Feminino
Meia-Idade
Tipo de Publ: Relatos de Casos
Responsável: BR1.1 - BIREME



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