In the 7/23/04 AIDS article titled "Relationship between
drug resistance and HIV-1 disease progression or death in
patients undergoing resistance testing," Lucas et al. (Johns
Hopkins University) state:
"Our finding that the extent of antiretroviral resistance
was not associated with HIV-1 disease progression or death
is somewhat counterintuitive."
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Lucas GM, Gallant JE, Moore RD. Relationship between drug
resistance and HIV-1 disease progression or death in
patients undergoing resistance testing. AIDS 2004 Jul
23;18:1539-1548.
John Hopkins University, Baltimore, Maryland, USA. Email:
glucas@jhmi.edu
Abstract: Objective: To evaluate factors associated with
drug resistance detected by genotypic antiretroviral
resistance testing (GART), and to determine the association
between the level of resistance and subsequent human
immunodeficiency type 1 (HIV-1) disease progression or
death. Design: Observational cohort study.
Methods: We identified highly active antiretroviral therapy
(HAART)- treated patients who had GART as part of clinical
management. Factors associated with greater numbers of
resistance mutations were assessed by ordinal logistic
regression. Survival analysis was used to assess time to a
new opportunistic condition or death following GART.
Results: A total of 572 patients were identified who had
GART: of these, 50% had 0-2 resistance mutations, 33% had
3-6 mutations, and 17% had >= 7 mutations. In multivariate
analysis, prolonged use of HAART in the setting of
incomplete viral suppression was significantly associated
with more drug resistance. Patients with fewer resistance
mutations were significantly more likely to achieve viral
suppression after GART than patients with more mutations.
Compared to patients with two or less resistance mutations,
those with three to six mutations, or seven or more
mutations were not at higher risk of HIV-1 disease
progression or death over a median follow-up of 15 months.
In contrast, continued HAART use following GART was strongly
associated with slower disease progression, particularly at
lower CD4 cell counts.
Conclusion: These results support the hypothesis the
drug-resistant HIV-1 may be less pathogenic than wild-type
virus, and that continued use of HAART might provide
clinical benefit, despite persistent viremia and HIV-1 drug
resistance.
