The cumulative occurrence of resistance mutations in the HIV-1 protease gene is associated with failure of salvage therapy with ritonavir and saquinavir in protease inhibitor-experienced patients
M. Karmochkine et al., The cumulative occurrence of resistance mutations in the HIV-1 protease gene is associated with failure of salvage therapy with ritonavir and saquinavir in protease inhibitor-experienced patients, ANTIVIR RES, 47(3), 2000, pp. 179-188
Salvage therapy with ritonavir (RTV) and saquinavir (SQV) failed to achieve
virological and immunological improvement in 24 HIV-infected patients who
discontinued triple therapy with RTV or indinavir (IDV) because of failure
or intolerance to treatment. Changes in the HIV-1 protease gene sequence we
re analyzed prospectively in 14 patients. No primary protease mutation was
found prior to the use of protease inhibitors. After 7 months of treatment
with IDV or RTV, primary resistance mutations at codons pol 46 and/or pol 8
2 were observed in 11 of 13 patients. After 16 weeks on RTV-SQV, novel prim
ary mutations related to SQV emerged in 7 of 13 patients, together with an
increase in the number of secondary resistance mutations. Our observations
indicate that the cumulative occurrence of resistance mutations in the prot
ease gene was associated with failure of antiretroviral therapy. The presen
ce of mutations to a first protease inhibitor may represent a risk factor f
or the failure of a subsequent treatment with a second line protease inhibi
tor. (C) 2000 Elsevier Science B.V. All rights reserved.