Human immunodeficiency virus type 1 protease genotype predicts immune and viral responses to combination therapy with protease inhibitors (PIs) in PI-naive patients
Ee. Perez et al., Human immunodeficiency virus type 1 protease genotype predicts immune and viral responses to combination therapy with protease inhibitors (PIs) in PI-naive patients, J INFEC DIS, 183(4), 2001, pp. 579-588
Protease genotype, as a variable in outcome to combination therapy for huma
n immunodeficiency virus (HIV) type 1 infection, was evaluated among protea
se inhibitor-naive children and adolescents who had received extensive trea
tment with reverse-transcriptase inhibitors. After 24 weeks of combination
therapy, 35% had viral and immune success (VSIS patients), 19% had viral an
d immune failure (VFIF patients), and 46% had viral failure but marked impr
ovement in CD4 T cells (VFIS patients). Disease stage was the only prethera
py clinical variable associated with outcome (P = .02). Although reverse-tr
anscriptase genotype was unrelated to outcome, pretherapy protease genotype
was related significantly to therapy response (P = .005). Odds for immune
or viral failure were 17.7 to 1 and 2.5 to 1, respectively, for protease ge
notype as a single variable. Protease genotype combined with disease stage
and CD4 cell percentage predicted correct therapy response for 81% of patie
nts (100% of VFIF, 78% of VSIS, and 75% of VFIS patients). Naturally occurr
ing amino acid polymorphisms in protease provide sensitive biomarkers for t
reatment response among inhibitor-naive patients with advanced HIV disease.