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Sexual Transmission of Multi-Drug Resistant HIV-1
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written by Douglas Mayers, M.D.
published on HIVresistanceWeb: September 25, 1998
The authors describe the first documented transmission of PI-resistant, multi-drug resistant HIV-1. A homosexual man had unprotected sex with a partner who had a significant history of prior use of antiretroviral drugs and admitted poor compliance with treatment. Plasma virus obtained at the time of seroconversion showed both genetic evidence and in vitro phenotypic evidence of resistance to AZT, 3TC, saquinavir, ritonavir, indinavir, and nelfinavir. Genetic analysis of the env and pol genes of viruses from the source and index patient revealed a close relationship between the two viruses. The index patient had a delayed response to therapy with AZT, 3TC, delavirdine and nelfinavir compared to 36 other patients with primary HIV infection treated with similar drug combinations. An associated editorial written by Drs. Oren Cohen and
Anthony Fauci concludes: "Appropriate prescription of potent antiretroviral regimens, maximal adherence to the regimen, the development of new drugs directed against different stages of the viral-replication cycle, and the creation of accurate and reliable assays to assess drug resistance are all essential for the successful long-term control of HIV replication."
This report highlights the ongoing problem of primary infection with drug-resistant HIV-1. Combination antiretroviral drug regimens have had a profound impact on the course of HIV-1 disease in developed countries. The continued expansion of the use of these drugs into patients with earlier stages of HIV disease comes with a price. Many of these patients feel better without medication than when they are being treated. Long-term consequences of RTI/PI combination regimens include myopathy, neuropathy, pancreatitis, diabetes, hyperlipidemia and lipodystrophy. Because of the problems with lifelong compliance/adherence with these complicated drug regimens, expanded use of these drug combinations will inevitably result in an increasing pool of persons with multi-drug resistant HIV-1. This challenges health care workers and the public health system to promote safer sex practices in HIV-affected communities and develop surveillance systems to monitor the rates of transmission in high risk populations, including new seroconverters, infants of antiretroviral-experienced HIV-infected mothers, and health care workers who seroconvert after needlestick exposures. Best estimates of the rates of drug-resistant seroconversion in adults in the United States and Europe in 1998 would be: AZT resistance—7.5 %, 3TC resistance—8%, NNRTI resistance—rare (but anticipated to rise in the next year), and PI resistance—3 to 5%. These rates are expected to rise in the next few years unless more acceptable, user friendly drug regimens can be developed for the HIV-infected community.
Related HIVresistanceWeb Articles:
The World is not flat! Safer sex must be the rule!
(Bruce Polsky, April/May 1998)
Report From the Second International Workshop on Drug Resistance and Treatment Strategies (24-27 June, Lake Maggiore, Italy): Protease Inhibitor Drug Resistance.
(Douglas Mayers, July/August)
Report From the Second International Workshop on Drug Resistance and Treatment Strategies (24-27 June, Lake Maggiore, Italy): Resistance to Reverse Transcriptase Inhibitors.
(Charles Boucher, July/August 1998)
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