Navegando por Palavras-chave "Drug Resistance"

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    Análise de prevalência do perfil mutacional de resistência aos antirretrovirais entre indivíduos em falha ao primeiro esquema antirretroviral com ITRNN no Brasil
    (Universidade Federal de São Paulo (UNIFESP), 2020-03-05) Dias, Danilo Araujo [UNIFESP]; Diaz, Ricardo Sobhie [UNIFESP]; Universidade Federal de São Paulo
    Introduction: Antiretroviral treatment has proven to be increasingly effective and well-tolerated over time. However, drug resistance mutations have an important impact and could be a major issue especially to cases in which the first line of treatment is affected. Until recently, the first-line treatment was two (NRTI) and one (NNRTI) or efavirenz. Objective:To identify and to analyze the prevalence of resistance mutations in the reverse transcriptase (RT) region of HIV pol gene, in patients with virological failure to 2 NRTI and 1 NNRTI schemes, and with available viral genotyping. Methodology: 2934 genotyping reports made by Renageno between December/2015 to June/2017 containing evidence of first-line scheme virological failure were analyzed. The interpretation of resistance mutations was made using the Stanford University algorithm (IAS-USA database), through the Sisgeno platform, in which data such as sex, geographic location, age, viral subtype, and therapeutic scheme were extracted. Viral load and T-CD4+ counts were extracted by Siscel. Descriptive statistics and hypothesis test on categorical variables were performed by SPSS program. Graphs were prepared using Graph Pad Prisma and excel program, and multivariate analysis (ANOVA) was performed using R program. Results: The prevalence of cases was higher in the state of São Paulo (23.3%). Overall, the majority were male (69.3%), the mean of CD4 T cell count was 315 cells/mm3, the mean viral load was 154,897 copies/ml, and the mean of treatment time was 3.8 years. The most predominant subtype was B (73.2%), followed by C (15.7%) and F (11%). The predominant antiretroviral scheme was TLE (65.3%) follow by and AZT + 3TC + EFV (25.2%). The most abundant drug resistance mutations were M184I/V (59.8%) and K103N (52.5%). The accumulation of mutations in individuals exposed to EFV schemes was 78.22% in the NRTI group and 56.82% analyzing NRTI mutations and M184I/V together. In the individuals using NVP schemes, the drug resistance mutation prevalence was 76,91% and 62.74%, respectively. The number of mutations did not change the viral load according to the treatment time. The South, Southeast and Midwest regions showed similar drug resistance rates, unlike the North and Northeast, which showed higher mutations. Individuals withxx subtypes B and F presented more mutations. Men presented higher mutations than women and the prevalence of mutations was not related to age. Crossresistance to RPV showed a higher prevalence in individuals with subtype B. Regarding DOR, subtype C presented a differential mutational profile. AZT could be an alternative for a switch in schemes with EFV. Conclusion: In Brazil, the accumulation of drug resistance mutations to the first-line treatment using NNRTI is higher compared to other regions. The number of mutations in the NNRTI did not affect the viral load and treatment time. The North and Northeast regions accumulated more mutations. A proposed scheme should have DOR, RPV and ETR rescue should be evaluated regarding crossresistance.