AIDSWEEKLY Plus; Monday, November 8, 2004
Staff Medical Writers

"Primary, or transmitted, drug resistance is common among treatment naive patients recently infected with HIV-1, and impairs response to anti-retroviral therapy," wrote investigators in the United States.

"We previously observed that patients with secondary resistance (developed in response to anti-retroviral treatment) who chose to stop an anti-retroviral regimen experience rapid overgrowth of drug resistant viruses by wild-type virus of higher pol replication capacity.

"We sought to determine if primary drug resistance would be lost at a rapid rate, and viral pol replication capacity would increase, in the absence of treatment," said J.D. Barbour and colleagues.

"We tracked drug resistance phenotype, genotype, viral pol replication capacity (single cycle recombinant assay incorporating a segment of the patient pol gene [pol RC]), plasma HIV-1 RNA, and CD4 T cell counts in the absence of treatment among patients in early HIV-1 infection," the authors said.

The researchers found that "six of 22 patients had evidence of primary drug resistance to at least one class of drug; three resistant to protease inhibitors, three resistant to non-nucleoside reverse transcriptase inhibitors, and four resistant to nucleoside reverse transcriptase inhibitors.

"All six patients maintained evidence of drug resistance for the period of observation. Among patients with baseline primary drug resistance pol RC did not increase over time."

"In contrast to secondary resistant infections that are rapidly overgrown when therapy is stopped," Barbour concluded, "primary drug resistance persists over time. Surveillance and clinical detection of primary resistance is feasible in the first year of infection."

Barbour and colleagues published their study in AIDS (Persistence of primary drug resistance among recently HIV-1 infected adults. AIDS. 2004 Aug 20;18(12):1683-9.

For additional information, contact R.M. Grant, Gladstone Institute Virology & Immunology, POB 419100, San Francisco, CA 94141, USA.

Publisher contact information for the journal AIDS is: Lippincott Williams & Wilkins, 530 Walnut St., Philadelphia, PA 19106-3621, USA.

The information in this article comes under the major subject areas of HIV/AIDS, Drug Resistance, Viral Evolution, Antiretroviral Therapy, and Genomics and Genetics.

This article was prepared by AIDS Weekly editors from staff and other reports.

Reference

Barbour JD, Hecht FM, Wrin T, et al., "Persistence of primary drug resistance among recently HIV-1 infected adults", AIDS. 2004 Aug 20;18(12):1683-9

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