Bernard L, Peytavin G, Mathez D, De Truchis P, Vuagnat A, Bani-Sadr F, Sayada C, Leibowitch J, Farinotti R, Perronne C; Interscience Conference on Antimicrobial Agents and Chemotherapy.
Abstr Intersci Conf Antimicrob Agents Chemother Intersci Conf Antimicrob Agents Chemother. 1998 Sep 24-27; 38: 22 (abstract no. A-71).
Hopital Raymond Poincare, Faculte Paris-Ouest, Garches, France.
Missing doses and/or bad absorption of protease inhibitors (PI) can be a source of failure of HAART. In a prospective study, 30 HIV-infected pts, naive of PI and with a positive HIV viremia (Amplicor), were given HAART including IDV. Pts were classified as responders (R) or non-responders (NR) according to the persistence or not of viremia (>50 copies/ml). A band of hair was cut near the scalp and was cut into 2-cm segments. IDV level was monitored in hair samples in order to search a correlation with the response to HAART. The selection of HIV protease gene mutations (PGM) was searched in the strains of NR pts (TruGene HIV1) with viremia >500 copies/ml. 19 pts were R and 11 were NR. In the first 2 cm-segment, hair IDV levels were higher in R than in NR pts (17.85 +/- 5.08 vs 8.01 +/- 5.39 mg/g) (P=0.0002). IDV levels were also higher in the more distal hair segments of R pts (2nd segment : 21.52 vs 5.8 mg/g ; 3rd: 15.62 vs 6.28 mg/g; 4th: 12.7 vs 1.94 mg/g). In individual pts, a drop of IDV level in a hair segment was time-correlated with a marked increase of viremia, and vice-versa. No PGM was detected before HAART. PGM could be searched in strains of 10 out of 11 NR pts. The 3 NR pts with a high hair IDV level (>10 mg/g) had strains with several PGM (,,3 specific mutations). Among the 7 NR pts with a low hair IDV level, 5 had susceptible strains and 2 had strains with several PGM. In NR patients, inefficacy of HAART was linked to low hair IDV levels and/or PGM. Thus, the monitoring of hair PI levels allows the detection of poor adherence or absorption and, combined to the detection of HIV PGM, should highly facilitate the management of HAART in NR pts.
Publication Types:
Keywords:
- AIDS Vaccines
- Acquired Immunodeficiency Syndrome
- Antiretroviral Therapy, Highly Active
- HIV Infections
- HIV Seropositivity
- HIV-1
- Humans
- Indinavir
- Longitudinal Studies
- Prospective Studies
- Viremia
Other ID:
UI: 102187974
From Meeting Abstracts