VIRAL PHENOTYPE, ANTIRETROVIRAL RESISTANCE AND CLINICAL EVOLUTION IN HUMAN IMMUNODEFICIENCY VIRUS-INFECTED CHILDREN

Background, The syncytium-inducing (SI) viral phenotype and the emerge nce of viral strains resistant to zidovudine have been described in pe rsons infected with HIV, and in some cases they have been associated w ith poor prognosis, Methods, HIV isolates obtained from 37 HIV-infecte d children were analyzed to determine whether the SI viral phenotype a nd the mutation on the 215 position of the reverse transcriptase (M215 ) could be used as markers of disease progression. We performed periph eral blood coculture mononuclear cells, and we analyzed the induction of syncytia using the MT-2 cell line, The emergence of mutations on th e 215 position was determined by PCR, Results, We found a statisticall y significant association (P < 0.05) between SI viral phenotype and (1 ) recurrent serious bacterial infections, (2) absolute CD4(+) cell cou nts <2 SD, (3) progression to AIDS and (4) death. Sixty percent of the children treated with zidovudine developed 215 mutant viral strains w ithout statistically significant association with clinical or immunolo gic findings. The SI viral phenotype was statistically associated with the presence of the 215 mutation (P < 0.05), Conclusions. SI viral ph enotype is a marker associated with a poor clinical and immunologic pr ogression of the disease and it may facilitate the emergence of mutant strains in children treated with zidovudine.