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Alessandri-Gradt E, Moisan A, Plantier JC. HIV-1 Non-Group M Strains and ART. Viruses 2023; 15:v15030780. [PMID: 36992488 PMCID: PMC10058373 DOI: 10.3390/v15030780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 03/09/2023] [Accepted: 03/10/2023] [Indexed: 03/31/2023] Open
Abstract
To eliminate HIV infection, there are several elements to take into account to limit transmission and break viral replication, such as epidemiological, preventive or therapeutic management. The UNAIDS goals of screening, treatment and efficacy should allow for this elimination if properly followed. For some infections, the difficulty is linked to the strong genetic divergence of the viruses, which can impact the virological and therapeutic management of patients. To completely eliminate HIV by 2030, we must therefore also be able to act on these atypical variants (HIV-1 non-group M) which are distinct from the group M pandemic viruses. While this diversity has had an impact on the efficacy of antiretroviral treatment in the past, recent data show that there is real hope of eliminating these forms, while maintaining vigilance and constant surveillance, so as not to allow more divergent and resistant forms to emerge. The aim of this work is therefore to share an update on the current knowledge on epidemiology, diagnosis and antiretroviral agent efficacy of HIV-1 non-M variants.
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Affiliation(s)
- Elodie Alessandri-Gradt
- Univ Rouen Normandie, UNICAEN, INSERM, DYNAMICURE UMR 1311, and CHU Rouen, Department of Virology, National Reference Center of HIV, F-76000 Rouen, France
| | - Alice Moisan
- Univ Rouen Normandie, UNICAEN, INSERM, DYNAMICURE UMR 1311, and CHU Rouen, Department of Virology, National Reference Center of HIV, F-76000 Rouen, France
| | - Jean-Christophe Plantier
- Univ Rouen Normandie, UNICAEN, INSERM, DYNAMICURE UMR 1311, and CHU Rouen, Department of Virology, National Reference Center of HIV, F-76000 Rouen, France
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Ndashimye E, Reyes PS, Arts EJ. New antiretroviral inhibitors and HIV-1 drug resistance: more focus on 90% HIV-1 isolates? FEMS Microbiol Rev 2023; 47:fuac040. [PMID: 36130204 PMCID: PMC9841967 DOI: 10.1093/femsre/fuac040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/13/2022] [Accepted: 09/18/2022] [Indexed: 01/21/2023] Open
Abstract
Combined HIV antiretroviral therapy (cART) has been effective except if drug resistance emerges. As cART has been rolled out in low-income countries, drug resistance has emerged at higher rates than observed in high income countries due to factors including initial use of these less tolerated cART regimens, intermittent disruptions in drug supply, and insufficient treatment monitoring. These socioeconomic factors impacting drug resistance are compounded by viral mechanistic differences by divergent HIV-1 non-B subtypes compared to HIV-1 subtype B that largely infects the high-income countries (just 10% of 37 million infected). This review compares the inhibition and resistance of diverse HIV-1 subtypes and strains to the various approved drugs as well as novel inhibitors in clinical trials. Initial sequence variations and differences in replicative fitness between HIV-1 subtypes pushes strains through different fitness landscapes to escape from drug selective pressure. The discussions here provide insight to patient care givers and policy makers on how best to use currently approved ART options and reduce the emergence of drug resistance in ∼33 million individuals infected with HIV-1 subtype A, C, D, G, and recombinants forms. Unfortunately, over 98% of the literature on cART resistance relates to HIV-1 subtype B.
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Affiliation(s)
- Emmanuel Ndashimye
- Department of Microbiology and Immunology, Western University Schulich School of Medicine & Dentistry, Western University, N6A 3K7, London, Ontario, Canada
- Joint Clinical Research Centre, -Center for AIDS Research Laboratories, 256, Kampala, Uganda
| | - Paul S Reyes
- Department of Microbiology and Immunology, Western University Schulich School of Medicine & Dentistry, Western University, N6A 3K7, London, Ontario, Canada
| | - Eric J Arts
- Department of Microbiology and Immunology, Western University Schulich School of Medicine & Dentistry, Western University, N6A 3K7, London, Ontario, Canada
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Martin C, Unal G, Plantier JC, Alessandri-Gradt E. Bictegravir-based antiretroviral therapy in HIV-1 group O patients: data from real-life bictegravir/emtricitabine/tenofovir alafenamide switches. J Antimicrob Chemother 2022; 77:2305-2307. [PMID: 35488848 DOI: 10.1093/jac/dkac143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Charlène Martin
- Normandie Univ, UNIROUEN, Inserm UMR 1311 DYNAMICURE, CHU Rouen, 76000 Rouen, France
| | - Guillemette Unal
- Normandie Univ, UNIROUEN, Inserm UMR 1311 DYNAMICURE, CHU Rouen, 76000 Rouen, France
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Martin C, Gracias S, Charpentier C, Descamps D, Le Hingrat Q, Plantier JC, Alessandri-Gradt E. HIV-1 non-group M phenotypic susceptibility in vitro to bictegravir and cabotegravir. J Antimicrob Chemother 2021; 76:2306-2309. [PMID: 34151963 DOI: 10.1093/jac/dkab196] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2021] [Accepted: 05/16/2021] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES HIV-1 group O (HIV-1/O) is one of the four HIV-1 groups and is endemic in Cameroon, representing 1% of HIV-1 infections in the population. Around 50% of the strains of this group naturally show a mutation (Y181C) providing them with resistance to NNRTIs and making therapeutic management more difficult. Today, the WHO recommends the use of integrase strand transfer inhibitors (INSTIs) as first-line treatment. Bictegravir and cabotegravir are the two most recent INSTIs. Because of the genetic polymorphism of HIV-1/O, studies are required to evaluate their phenotypic susceptibility to these two drugs. PATIENTS AND METHODS We performed a phenotypic study on a large panel including 41 HIV-1/O clinical isolates and other rare non-group M HIV-1 (2 HIV-1/N and 1 HIV-1/P) to evaluate in vitro susceptibility to bictegravir and cabotegravir. RESULTS The results showed an overall susceptibility of non-group M strains to the two drugs compared with HIV-1 group M. There was no difference between the mean (min-max) IC50 of HIV-1/M [1.86 (0.93-4.12) and 5.24 (1.76-12.41) nM for bictegravir and cabotegravir, respectively] and HIV-1/non-M [2.17 (0.03-9.47) and 4.88 (0.02-15.64) nM for bictegravir and cabotegravir, respectively]. However, we found a significant difference between IC50 values for bictegravir and cabotegravir in the whole panel (P value < 0.001). CONCLUSIONS This study has shown encouraging results regarding the clinical use of these drugs in HIV-1/non-M-infected patients, which will need to be confirmed with clinical data.
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Affiliation(s)
- Charlène Martin
- Normandie Univ, UNIROUEN, EA2656, GRAM 2.0, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, F-76000, Rouen, France
| | - Ségolène Gracias
- Normandie Univ, UNIROUEN, EA2656, GRAM 2.0, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, F-76000, Rouen, France
| | - Charlotte Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Diane Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Quentin Le Hingrat
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Jean-Christophe Plantier
- Normandie Univ, UNIROUEN, EA2656, GRAM 2.0, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, F-76000, Rouen, France
| | - Elodie Alessandri-Gradt
- Normandie Univ, UNIROUEN, EA2656, GRAM 2.0, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, F-76000, Rouen, France
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Kouanfack C, Unal G, Schaeffer L, Kfutwah A, Aghokeng A, Mougnutou R, Tchemgui-Noumsi N, Alessandri-Gradt E, Delaporte E, Simon F, Vray M, Plantier JC. Comparative Immunovirological and Clinical Responses to Antiretroviral Therapy Between HIV-1 Group O and HIV-1 Group M Infected Patients. Clin Infect Dis 2021; 70:1471-1477. [PMID: 31063537 DOI: 10.1093/cid/ciz371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2018] [Accepted: 05/06/2019] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Little is known about impact of genetic divergence of human immunodeficiency virus type 1 group O (HIV-1/O) relative to HIV-1 group M (HIV-1/M) on therapeutic outcomes. We aimed to determine if responses to standardized combination antiretroviral therapy (cART) were similar between groups despite strain divergence. METHODS We performed an open nonrandomized study comparing the immunological, virological, and clinical responses to cART based on 2 nucleoside reverse transcriptase inhibitors plus 1 ritonavir-boosted protease inhibitor, in naive and paired HIV-1/O vs HIV-1/M infected (+) patients (ratio 1:2), matched on several criteria. The primary endpoint was the proportion of patients with undetectable plasma viral load (pVL, threshold 60 copies/mL) at week (W) 48. Secondary endpoints were the proportion of patients with undetectable pVL at W24 and W96 and CD4 evolution between baseline and W24, W48, and W96. RESULTS Forty-seven HIV-1/O+ and 94 HIV-1/M+ patients were included. Mean pVL at baseline was significantly lower by 1 log for HIV-1/O+ vs HIV-1/M+ patients. At W48, no significant difference was observed between populations with undetectable pVL and differences at W24 and W96 were not significant. A difference in CD4 gain was observed in favor of HIV-1/M at W48 and W96, but this was not significant when adjusted on both matched criteria and pVL at baseline. CONCLUSIONS Our data demonstrate similar immunovirological and clinical response between HIV-1/O+ and HIV-1/M+ patients. They also reveal significantly lower baseline replication for HIV-1/O variants, suggesting specific virological properties and physiopathology that now need to be addressed. CLINICAL TRIALS REGISTRATION NCT00658346.
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Affiliation(s)
- Charles Kouanfack
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Yaoundé Central Hospital, Cameroon
| | - Guillemette Unal
- Normandy Université, Université de Rouen Normandie, Groupe de Recherche sur l'Adaptation Microbienne, EA Rouen University Hospital, Laboratory of Virology associated with the National Reference Centre for HIV
| | - Laura Schaeffer
- Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France
| | | | - Avelin Aghokeng
- Recherche Translationnelle sur le VIH et les Maladies Infectieuses, University of Montpellier, Institut de Recherche et pour le Développement, Institut National de la Santé et de la Recherche Médicale
| | - Rose Mougnutou
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Yaoundé Central Hospital, Cameroon
| | - Nathalie Tchemgui-Noumsi
- Faculty of Medicine and Pharmaceutical Sciences, University of Dschang, Yaoundé Central Hospital, Cameroon
| | - Elodie Alessandri-Gradt
- Normandy Université, Université de Rouen Normandie, Groupe de Recherche sur l'Adaptation Microbienne, EA Rouen University Hospital, Laboratory of Virology associated with the National Reference Centre for HIV
| | - Eric Delaporte
- Recherche Translationnelle sur le VIH et les Maladies Infectieuses, University of Montpellier, Institut de Recherche et pour le Développement, Institut National de la Santé et de la Recherche Médicale
| | - François Simon
- Faculty of Medicine Paris Diderot, University Hospital Saint Louis, Paris, France
| | - Muriel Vray
- Unit of Epidemiology of Emerging Diseases, Institut Pasteur, Paris, France
| | - Jean-Christophe Plantier
- Normandy Université, Université de Rouen Normandie, Groupe de Recherche sur l'Adaptation Microbienne, EA Rouen University Hospital, Laboratory of Virology associated with the National Reference Centre for HIV
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Berger A, Muenchhoff M, Hourfar K, Kortenbusch M, Ambiel I, Stegmann L, Heim A, Sarrazin C, Ehret R, Daniel V, Wasner M, Plantier JC, Eberle J, Gürtler L, Haberl AE, Stürmer M, Keppler OT. Severe underquantification of HIV-1 group O isolates by major commercial PCR-based assays. Clin Microbiol Infect 2020; 26:1688.e1-1688.e7. [PMID: 32184172 DOI: 10.1016/j.cmi.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 03/02/2020] [Accepted: 03/05/2020] [Indexed: 11/16/2022]
Abstract
HIV-1 diversity poses major challenges to viral load assays because genetic polymorphisms can impede nucleic acid detection. In addition to the on-going viral diversification within the HIV-1 group M pandemic, HIV-1 genetic diversity is further increased by non-group M infections, such as HIV-1 groups O (HIV-1-O), N and P. We here conducted a systematic evaluation of commercially available PCR assays to detect HIV-1-O isolates. We collected 25 primary HIV-1-O isolates covering all genetic clusters within HIV-1-O. Subsequently, this panel of isolates was tested on eight commercially available quantitative and five qualitative HIV-1 PCR-based assays in serial dilutions. Sequence analyses were performed for severe cases of underquantification or lack of detection. We observed differences between the assays in quantification that depended on the HIV-1-O isolate's subgroup. All three tested HIV-1-O subgroup IV isolates were underquantified by the Roche CAP/CTM >800-fold compared to the Abbott RealTime assay. In contrast, the latter assay underquantified several subgroup I isolates >200-fold. Notably, the Xpert HIV-1 Viral Load test from Cepheid failed to detect two of the HIV-1-O isolates, whereas the Roche Cobas 8800 assay readily detected all isolates. Comparative sequence analyses identified polymorphisms in the HIV-1-O long-terminal repeat and integrase genes that likely underlie inadequate nucleic acid amplification. Potential viral load underquantification should be considered in therapeutic monitoring of HIV-1-O-infected patients. Pre-clinical assessments of HIV-1 diagnostic assays could be harmonized by establishing improved and internationally standardized panels of HIV-1 isolates that cover the dynamic diversity of circulating HIV-1 strains.
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Affiliation(s)
- A Berger
- Institute of Medical Virology, University Hospital, Germany
| | - M Muenchhoff
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Germany; German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany
| | - K Hourfar
- German Red Cross, Baden-Wuerttemberg-Hessen, Institute of Transfusion Medicine and Immunochemotherapy, Germany
| | - M Kortenbusch
- Institute of Medical Virology, University Hospital, Germany
| | - I Ambiel
- Institute of Medical Virology, University Hospital, Germany
| | - L Stegmann
- Institute of Medical Virology, University Hospital, Germany
| | - A Heim
- Institute for Virology, Hannover Medical School, Hannover, Germany
| | - C Sarrazin
- Department of Internal Medicine 1, University Hospital, Germany
| | - R Ehret
- MVZmib AG, Medical Center for Infectious Diseases, Berlin, Germany
| | - V Daniel
- Transplantation Immunology, Institute of Immunology, University Hospital Heidelberg, Heidelberg, Germany
| | - M Wasner
- KH Labor GmbH, AMEOS Group, Bernburg, Germany
| | - J-C Plantier
- Normandy University, UNIROUEN, GRAM EA2656, Rouen University Hospital, Laboratory of Virology Associated with the National Reference Centre for HIV, Rouen, France
| | - J Eberle
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Germany
| | - L Gürtler
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Germany
| | - A E Haberl
- Internal Medicine II, Department for Infectious Diseases, University Hospital, Goethe University, Germany
| | - M Stürmer
- Institut für Medizinische Diagnostik, Subunit Laboratory Frankfurt, Frankfurt, Germany
| | - O T Keppler
- Max von Pettenkofer Institute & Gene Center, Virology, National Reference Center for Retroviruses, LMU München, Germany; German Center for Infection Research (DZIF), Partner Site Munich, Munich, Germany.
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Unal G, Alessandri-Gradt E, Leoz M, Pavie J, Lefèvre C, Panjo H, Charpentier C, Descamps D, Barin F, Simon F, Meyer L, Plantier JC. Human Immunodeficiency Virus Type 1 Group O Infection in France: Clinical Features and Immunovirological Response to Antiretrovirals. Clin Infect Dis 2019; 66:1785-1793. [PMID: 29272369 DOI: 10.1093/cid/cix1087] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 12/19/2017] [Indexed: 11/13/2022] Open
Abstract
Background To obtain reliable clinical data of human immunodeficiency virus type 1 group O (HIV-1/O) infection, and immunovirological responses to combination antiretroviral therapy (cART), in a large series of 101 patients. Methods Piecewise linear models were used to estimate CD4 count before and after cART initiation. Kaplan-Meier survival curves were used to estimate time to reach clinical stage C before antiretroviral therapy (ART) and to analyze time to achieve a plasma viral load (pVL) <40 copies/mL following cART initiation. Immunovirological response was assessed at the most recent visit in patients on active follow-up. Results Data showed a 16.6% cumulative probability of reaching stage C within 5 years following diagnosis, and a mean CD4 decrease of -30.5 cells/μL/year. cART initiation in ART-naive patients led to a mean CD4 gain of 147 cells/μL after 12 months, and to a median pVL of <40 copies/mL after 3.8 months for 89.3%. Initiation with a nonrecommended nonnucleoside reverse transcriptase inhibitor-based vs a ritonavir-boosted protease inhibitor-based regimen resulted in a much smaller gain of around 100 CD4 cells/μL after 1 year. Patients on follow-up since 2007 had a median CD4 count of 498 cells/μL, and 87% had a pVL <40 copies/mL at the most recent follow-up visit. Conclusions This work provides unique data on HIV-1/O infection, in favor of a milder natural evolution than HIV-1 group M (HIV-1/M) and of a highly efficient current management, based on HIV-1/M guidelines, despite genetic divergence. Studies of comparable HIV-1/M and HIV-1/O populations are needed to confirm these results.
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Affiliation(s)
- Guillemette Unal
- Normandie Université, Université de Rouen Normandie (UNIROUEN), Groupe de Recherche sur l'Adaptation Microbienne (GRAM) EA2656, Centre Hospitalier Universitaire (CHU) de Rouen, Laboratoire de Virologie, associé au Centre National de Référence (CNR) du Virus de l'Immunodéficience Humaine (VIH).,Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris-Saclay, Centre de recherche en Epidemiologie et Santé des Populations (CESP), Institut national de la santé et de la recherche médicale (INSERM) U1018, Centre de recherche en Epidémiologie et Santé des Populations, Le Kremlin Bicêtre
| | - Elodie Alessandri-Gradt
- Normandie Université, Université de Rouen Normandie (UNIROUEN), Groupe de Recherche sur l'Adaptation Microbienne (GRAM) EA2656, Centre Hospitalier Universitaire (CHU) de Rouen, Laboratoire de Virologie, associé au Centre National de Référence (CNR) du Virus de l'Immunodéficience Humaine (VIH)
| | - Marie Leoz
- Normandie Université, Université de Rouen Normandie (UNIROUEN), Groupe de Recherche sur l'Adaptation Microbienne (GRAM) EA2656, Centre Hospitalier Universitaire (CHU) de Rouen, Laboratoire de Virologie, associé au Centre National de Référence (CNR) du Virus de l'Immunodéficience Humaine (VIH)
| | - Juliette Pavie
- Hôpital Georges Pompidou, Faculté de Médecine, Paris Descartes, Assistance Publique-Hôpitaux de Paris (AP-HP)
| | - Clément Lefèvre
- Normandie Université, Université de Rouen Normandie (UNIROUEN), Groupe de Recherche sur l'Adaptation Microbienne (GRAM) EA2656, Centre Hospitalier Universitaire (CHU) de Rouen, Laboratoire de Virologie, associé au Centre National de Référence (CNR) du Virus de l'Immunodéficience Humaine (VIH)
| | - Henri Panjo
- Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris-Saclay, Centre de recherche en Epidemiologie et Santé des Populations (CESP), Institut national de la santé et de la recherche médicale (INSERM) U1018, Centre de recherche en Epidémiologie et Santé des Populations, Le Kremlin Bicêtre
| | - Charlotte Charpentier
- Hôpital Bichat-Claude Bernard, AP-HP, Laboratoire de Virologie, INSERM, Infections Antimicrobials Modelling Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Université Paris Diderot, Sorbonne Paris Cité
| | - Diane Descamps
- Hôpital Bichat-Claude Bernard, AP-HP, Laboratoire de Virologie, INSERM, Infections Antimicrobials Modelling Evolution (IAME), Unité Mixte de Recherche (UMR) 1137, Université Paris Diderot, Sorbonne Paris Cité
| | - Francis Barin
- Laboratoire de virologie associé au CNR du VIH, INSERM U966, CHU de Tours
| | - François Simon
- University Hospital Saint Louis, Faculté de Médecine Paris Diderot, Paris
| | - Laurence Meyer
- Faculté de Médecine Paris Sud, Université Paris Sud, Université Paris-Saclay, Centre de recherche en Epidemiologie et Santé des Populations (CESP), Institut national de la santé et de la recherche médicale (INSERM) U1018, Centre de recherche en Epidémiologie et Santé des Populations, Le Kremlin Bicêtre.,Hôpital de Bicêtre, AP-HP, Le Kremlin-Bicêtre, France
| | - Jean-Christophe Plantier
- Normandie Université, Université de Rouen Normandie (UNIROUEN), Groupe de Recherche sur l'Adaptation Microbienne (GRAM) EA2656, Centre Hospitalier Universitaire (CHU) de Rouen, Laboratoire de Virologie, associé au Centre National de Référence (CNR) du Virus de l'Immunodéficience Humaine (VIH)
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Alessandri-Gradt E, Charpentier C, Leoz M, Mourez T, Descamps D, Plantier JC. Impact of natural polymorphisms of HIV-1 non-group M on genotypic susceptibility to the attachment inhibitor fostemsavir. J Antimicrob Chemother 2019; 73:2716-2720. [PMID: 30032194 DOI: 10.1093/jac/dky271] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2018] [Accepted: 06/12/2018] [Indexed: 11/14/2022] Open
Abstract
Background Fostemsavir belongs to the new class of attachment inhibitors (AIs); it inhibits the entry of HIV into CD4+ T-lymphocytes by blocking conformational changes in gp120. This is a promising AI, but previous phenotypic data showed that genetically divergent HIV-1 group O could present natural resistance to this drug. These data were obtained from only two strains, which are not representative of the high intra-group genetic diversity. Moreover, no data are available concerning the other divergent HIV-1 groups (N and P). Objectives To further investigate the natural genotypic susceptibility of HIV-1 groups O, N and P (HIV-1 non-M) to fostemsavir, using a large set of sequences. Methods The frequency of eight substitutions associated with decreased susceptibility to fostemsavir (L116P, A204D, S375M/H, M426L, M434I, M475I and V506M), was investigated in 111 gp120 sequences from groups O (n = 100), N (n = 9) and P (n = 2). Results All HIV-1 group N sequences harboured the three substitutions S375M, M426L and M434I, whereas only 1% and 10% of HIV-1 group O sequences harboured the S375H + M426L and S375H + M434I patterns, respectively. The main genetic profile of HIV-1 groups P and O combined S375H with two atypical substitutions (M426S and M434L). Five group O sequences did not display any of the eight substitutions, but had atypical residues with unknown impact. Conclusions The genetic polymorphisms in the gp120 of HIV-1 non-M viruses support the hypothesis that these viruses could largely be resistant to inhibition by fostemsavir. Only 5% of group O strains could display full genetic susceptibility. Extensive phenotypic studies are now required.
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Affiliation(s)
- Elodie Alessandri-Gradt
- Normandie Univ, UNIROUEN, EA2656, GRAM, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, Rouen, France
| | - Charlotte Charpentier
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Marie Leoz
- Normandie Univ, UNIROUEN, EA2656, GRAM, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, Rouen, France
| | - Thomas Mourez
- Normandie Univ, UNIROUEN, EA2656, GRAM, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, Rouen, France
| | - Diane Descamps
- IAME, UMR 1137, INSERM, Université Paris Diderot, Sorbonne Paris Cité, AP-HP, Laboratoire de Virologie, Hôpital Bichat, AP-HP, Paris, France
| | - Jean-Christophe Plantier
- Normandie Univ, UNIROUEN, EA2656, GRAM, CHU de Rouen, Laboratoire de Virologie associé au CNR du VIH, Rouen, France
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Virological response to integrase strand transfer inhibitor-based antiretroviral combinations in HIV-1 group O-infected patients. AIDS 2019; 33:1327-1333. [PMID: 30950879 DOI: 10.1097/qad.0000000000002215] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
: Although integrase strand transfer inhibitors (INSTIs) are widely used in HIV-1 group M (HIV-1/M) infections, little is known about their efficacy against genetically divergent HIV-1 group O (HIV-1/O) strains. Previous phenotypic works have demonstrated the variable susceptibility of HIV-1/O strains, depending on INSTI drugs. Clinical data are very limited and obtained from a few patients. OBJECTIVES To investigate the virological success rate of an INSTI-based combination of antiretroviral therapy (cART) in a large population of HIV-1/O-infected patients, and to describe resistance-associated mutations (RAM) at virological failure. METHODS The virological response of 39 patients receiving INSTI-based cART during their follow-up was analysed i) at the last point of the first INSTI initiation and ii) at their most recent visit. RAM analysis was performed at virological failures. Resistance interpretation was based on the French National Agency of Research on AIDS and viral hepatitis (ANRS) rules. RESULTS Virological success at both time points of analysis was high, with more than 87% of the patients with undetectable plasma viral load. Among the six patients with virological failure, three selected RAM described for HIV-1/M resistance, and two had already RAM, before INSTI initiation. CONCLUSION Our results show that HIV-1/O infected patients receiving INSTI-based cART presented a high rate of virological success whatever their previous lines; we have also shown that resistance rules for HIV-1/M could be considered when failure occurs. These data are of importance especially in the context of WHO recommendations for a wider use of this class.
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In Vitro Antiviral Activity of Cabotegravir against HIV-2. Antimicrob Agents Chemother 2018; 62:AAC.01299-18. [PMID: 30012774 DOI: 10.1128/aac.01299-18] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2018] [Accepted: 07/12/2018] [Indexed: 02/08/2023] Open
Abstract
We examined the antiviral activity of the integrase inhibitor (INI) cabotegravir against HIV-2 isolates from INI-naive individuals. HIV-2 was sensitive to cabotegravir in single-cycle and spreading-infection assays, with 50% effective concentrations (EC50s) in the low to subnanomolar range; comparable results were obtained for HIV-1 in both assay formats. Our findings suggest that cabotegravir should be evaluated in clinical trials as a potential option for antiretroviral therapy and preexposure prophylaxis in HIV-2-prevalent settings.
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11
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Ngo-Malabo ET, Ngoupo T PA, Zekeng M, Ngono V, Ngono L, Sadeuh-Mba SA, Njouom R, Kfutwah A. A cheap and open HIV viral load technique applicable in routine analysis in a resource limited setting with a wide HIV genetic diversity. Virol J 2017; 14:224. [PMID: 29137673 PMCID: PMC5686852 DOI: 10.1186/s12985-017-0893-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2017] [Accepted: 11/07/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND HIV infection in Cameroon is characterized by a great viral diversity with all HIV-1 groups (M, N, O, and P) and HIV-2 in circulation. HIV group determination is very important if tailored viral load analysis and treatments are to be applied. In our laboratory, HIV viral load is carried out using two platforms; Biocentric and Abbott depending on the HIV group identified. Biocentric which quantifies HIV-1 group M is a cheap and open system useful in resource limited settings. The objective of this study was to compare the viral load analyses of serologically group-indeterminate HIV samples using the two platforms with the view of reducing cost. METHODS Consecutive samples received between March and May 2014, and between August and September 2014 in our laboratory for HIV viral load analysis were included. All these samples were analyzed for their HIV groups using an in-house ELISA serotyping test. All HIV-1 group M samples were quantified using the Biocentric test while all other known atypical samples (HIV-1 groups N, O and P) were analyzed using the Abbott technique. HIV group-indeterminate samples (by serotyping) were quantified with both techniques. RESULTS Among the 6355 plasma samples received, HIV-1 group M was identified in 6026 (94.82%) cases; HIV-1 group O, in 20 (0.31%); HIV-1 group M + O, in 3 (0.05%) and HIV-2, in 3 (0.05%) case. HIV-group indeterminate samples represented about 4.76% (303/6355) and only 231 of them were available for analysis by Abbott Real-Time HIV-1 and Generic HIV Viral Load techniques. Results showed that 188 (81.39%) samples had undetectable viral load in both techniques. All the detectable samples showed high viral load, with a mean of 4.5 log copies/ml (range 2.1-6.5) for Abbott Real-Time and 4.5 log copies/ml (range 2-6.4) for Generic HIV Viral Load. The mean viral load difference between the two techniques was 0.03 log10 copies/ml and a good correlation was obtained (r 2 = 0.89; P < 0.001). CONCLUSION Our results suggest that cheaper and open techniques such as Biocentric could be useful alternatives for HIV viral load follow-up quantification in resource limited settings like Cameroon; even with its high viral diversity.
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Affiliation(s)
| | - Paul Alain Ngoupo T
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | - Martin Zekeng
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | - Valérie Ngono
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | - Laure Ngono
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
| | | | - Richard Njouom
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon.
| | - Anfumbom Kfutwah
- Virology Department, Centre Pasteur of Cameroon, Po Box 1274, Yaounde, Cameroon
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Malet I, Subra F, Charpentier C, Collin G, Descamps D, Calvez V, Marcelin AG, Delelis O. Mutations Located outside the Integrase Gene Can Confer Resistance to HIV-1 Integrase Strand Transfer Inhibitors. mBio 2017. [PMID: 28951475 DOI: 10.1128/mbio.00922-17/asset/aaecbcca-7eaf-4566-ac85-49e1b03887ed/assets/graphic/mbo0051735020005.jpeg] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/27/2023] Open
Abstract
Resistance to the integrase strand transfer inhibitors raltegravir and elvitegravir is often due to well-identified mutations in the integrase gene. However, the situation is less clear for patients who fail dolutegravir treatment. Furthermore, most in vitro experiments to select resistance to dolutegravir have resulted in few mutations of the integrase gene. We performed an in vitro dolutegravir resistance selection experiment by using a breakthrough method. First, MT4 cells were infected with human immunodeficiency virus type 1 (HIV-1) Lai. After integration into the host cell genome, cells were washed to remove unbound virus and 500 nM dolutegravir was added to the cell medium. This high concentration of the drug was maintained throughout selection. At day 80, we detected a virus highly resistant to dolutegravir, raltegravir, and elvitegravir that remained susceptible to zidovudine. Sequencing of the virus showed no mutations in the integrase gene but highlighted the emergence of five mutations, all located in the nef region, of which four were clustered in the 3' polypurine tract (PPT). Mutations selected in vitro by dolutegravir, located outside the integrase gene, can confer a high level of resistance to all integrase inhibitors. Thus, HIV-1 can use an alternative mechanism to develop resistance to integrase inhibitors by selecting mutations in the 3' PPT region. Further studies are required to determine to what extent these mutations may explain virological failure during integrase inhibitor therapy.IMPORTANCE Integrase strand transfer inhibitors (INSTIs) are increasingly used both as first-line drugs and in rescue therapy because of their low toxicity and high efficacy in both treatment-naive and treatment-experienced patients. Until now, resistance mutations selected by INSTI exposure have either been described in patients or selected in vitro and involve the integrase gene. Most mutations selected by raltegravir, elvitegravir, or dolutegravir exposure are located inside the catalytic site of the integrase gene, but mutations outside the catalytic site of the integrase gene have also been selected with dolutegravir. Following in vitro selection with dolutegravir, we report, for the first time, a virus with selected mutations outside the HIV-1 integrase gene that confer resistance to all integrase inhibitors currently used to treat patients, such as raltegravir, elvitegravir, and dolutegravir. Our observation may explain why some viruses responsible for virological failure in patients treated with dolutegravir did not show mutations in the integrase gene.
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Affiliation(s)
- Isabelle Malet
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- Department of Virology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Frédéric Subra
- LBPA, ENS Cachan, CNRS UMR 8113, IDA, FR3242, Université Paris-Saclay, Cachan, France
| | - Charlotte Charpentier
- INSERM, IAME, UMR1137, Paris, France
- Université Paris Diderot, IAME, UMR1137, Sorbonne Paris Cité, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Virologie, Paris, France
| | - Gilles Collin
- INSERM, IAME, UMR1137, Paris, France
- Université Paris Diderot, IAME, UMR1137, Sorbonne Paris Cité, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Virologie, Paris, France
| | - Diane Descamps
- INSERM, IAME, UMR1137, Paris, France
- Université Paris Diderot, IAME, UMR1137, Sorbonne Paris Cité, Paris, France
- AP-HP, Hôpital Bichat, Laboratoire de Virologie, Paris, France
| | - Vincent Calvez
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- Department of Virology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Anne-Geneviève Marcelin
- Sorbonne Universités, UPMC Université Paris 06, INSERM, Institut Pierre Louis d'Epidémiologie et de Santé Publique (IPLESP UMRS 1136), Paris, France
- Department of Virology, AP-HP, Hôpital Pitié-Salpêtrière, Paris, France
| | - Olivier Delelis
- LBPA, ENS Cachan, CNRS UMR 8113, IDA, FR3242, Université Paris-Saclay, Cachan, France
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13
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Mutations Located outside the Integrase Gene Can Confer Resistance to HIV-1 Integrase Strand Transfer Inhibitors. mBio 2017; 8:mBio.00922-17. [PMID: 28951475 PMCID: PMC5615196 DOI: 10.1128/mbio.00922-17] [Citation(s) in RCA: 62] [Impact Index Per Article: 8.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023] Open
Abstract
Resistance to the integrase strand transfer inhibitors raltegravir and elvitegravir is often due to well-identified mutations in the integrase gene. However, the situation is less clear for patients who fail dolutegravir treatment. Furthermore, most in vitro experiments to select resistance to dolutegravir have resulted in few mutations of the integrase gene. We performed an in vitro dolutegravir resistance selection experiment by using a breakthrough method. First, MT4 cells were infected with human immunodeficiency virus type 1 (HIV-1) Lai. After integration into the host cell genome, cells were washed to remove unbound virus and 500 nM dolutegravir was added to the cell medium. This high concentration of the drug was maintained throughout selection. At day 80, we detected a virus highly resistant to dolutegravir, raltegravir, and elvitegravir that remained susceptible to zidovudine. Sequencing of the virus showed no mutations in the integrase gene but highlighted the emergence of five mutations, all located in the nef region, of which four were clustered in the 3′ polypurine tract (PPT). Mutations selected in vitro by dolutegravir, located outside the integrase gene, can confer a high level of resistance to all integrase inhibitors. Thus, HIV-1 can use an alternative mechanism to develop resistance to integrase inhibitors by selecting mutations in the 3′ PPT region. Further studies are required to determine to what extent these mutations may explain virological failure during integrase inhibitor therapy. Integrase strand transfer inhibitors (INSTIs) are increasingly used both as first-line drugs and in rescue therapy because of their low toxicity and high efficacy in both treatment-naive and treatment-experienced patients. Until now, resistance mutations selected by INSTI exposure have either been described in patients or selected in vitro and involve the integrase gene. Most mutations selected by raltegravir, elvitegravir, or dolutegravir exposure are located inside the catalytic site of the integrase gene, but mutations outside the catalytic site of the integrase gene have also been selected with dolutegravir. Following in vitro selection with dolutegravir, we report, for the first time, a virus with selected mutations outside the HIV-1 integrase gene that confer resistance to all integrase inhibitors currently used to treat patients, such as raltegravir, elvitegravir, and dolutegravir. Our observation may explain why some viruses responsible for virological failure in patients treated with dolutegravir did not show mutations in the integrase gene.
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14
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De Oliveira F, Mourez T, Vessiere A, Ngoupo PA, Alessandri-Gradt E, Simon F, Rousset D, Plantier JC. Multiple HIV-1/M + HIV-1/O dual infections and new HIV-1/MO inter-group recombinant forms detected in Cameroon. Retrovirology 2017; 14:1. [PMID: 28086923 PMCID: PMC5237259 DOI: 10.1186/s12977-016-0324-3] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/15/2016] [Indexed: 11/10/2022] Open
Abstract
Background
Due to the prevalence of HIV-1 group M and the endemicity of HIV-1 group O infections in Cameroon, patients may be infected with both viruses and/or with HIV-1/MO recombinant forms. Such atypical infections may be deleterious in terms of diagnosis and therapeutic management due to the high divergence of HIV-1/O. The aim of this study was to identify prospectively such atypical infections in Cameroon. Results
Based on serological screening by env-V3 serotyping and a molecular strategy using group-specific (RT)-PCRs, we identified 10 Cameroonian patients harboring three different profiles of infection: (1) 4 HIV-1/M + O dual infections without evidence of recombinant; (2) 5 recombinants associated with one or both parental strains; and (3) 1 new recombinant form without parental strains. Conclusions This work highlights the dynamic co-evolution of these two HIV groups in Cameroon that could lead to the emergence of a circulating recombinant form MO, and the need for accurate identification of such atypical infections for precise diagnosis, virological monitoring and therapeutic management with adapted tools.
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Affiliation(s)
- Fabienne De Oliveira
- GRAM EA2656, Université de Rouen, Rouen, France.,Laboratoire de Virologie, Laboratoire associé au Centre National de Référence du VIH, CHU Charles Nicolle, 76031, Rouen Cedex, France
| | - Thomas Mourez
- GRAM EA2656, Université de Rouen, Rouen, France.,Laboratoire de Virologie, Laboratoire associé au Centre National de Référence du VIH, CHU Charles Nicolle, 76031, Rouen Cedex, France
| | - Aurélia Vessiere
- Centre Pasteur du Cameroun, Yaoundé, Cameroon.,Infectious Diseases Data Observatory, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | | | - Elodie Alessandri-Gradt
- GRAM EA2656, Université de Rouen, Rouen, France.,Laboratoire de Virologie, Laboratoire associé au Centre National de Référence du VIH, CHU Charles Nicolle, 76031, Rouen Cedex, France
| | - François Simon
- Service de Microbiologie, APHP, CHU Saint Louis, INSERM U941, Faculté de Médecine Paris Diderot, Paris, France
| | - Dominique Rousset
- Centre Pasteur du Cameroun, Yaoundé, Cameroon.,Laboratoire de Virologie, Institut Pasteur de le Guyane, Cayenne, Guyane française, France
| | - Jean-Christophe Plantier
- GRAM EA2656, Université de Rouen, Rouen, France. .,Laboratoire de Virologie, Laboratoire associé au Centre National de Référence du VIH, CHU Charles Nicolle, 76031, Rouen Cedex, France.
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15
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Tebit DM, Patel H, Ratcliff A, Alessandri E, Liu J, Carpenter C, Plantier JC, Arts EJ. HIV-1 Group O Genotypes and Phenotypes: Relationship to Fitness and Susceptibility to Antiretroviral Drugs. AIDS Res Hum Retroviruses 2016; 32:676-88. [PMID: 26861573 DOI: 10.1089/aid.2015.0318] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Despite only 30,000 group O HIV-1 infections, a similar genetic diversity is observed among the O subgroups H (head) and T (tail) (previously described as subtypes A, B) as in the 9 group M subtypes (A-K). Group O isolates bearing a cysteine at reverse transcriptase (RT) position 181, predominantly the H strains are intrinsically resistant to non-nucleoside reverse transcriptase inhibitors (NNRTIs). However, their susceptibility to newer antiretroviral drugs such as etravirine, maraviroc, raltegravir (RAL), and elvitegravir (EVG) remains relatively unknown. We tested a large collection of HIV-1 group O strains for their susceptibility to four classes of antiretroviral drugs namely nucleoside RT, non-nucleoside RT, integrase, and entry inhibitors knowing in advance the intrinsic resistance to NNRTIs. Drug target regions were sequenced to determine various polymorphisms and were phylogenetically analyzed. Replication kinetics and fitness assays were performed in U87-CD4(+)CCR5 and CXCR4 cells and peripheral blood mononuclear cells. With all antiretroviral drugs, group O HIV-1 showed higher variability in IC50 values than group M HIV-1. The mean IC50 values for entry and nucleoside reverse transcriptase inhibitor (NRTI) were similar for group O and M HIV-1 isolates. Despite similar susceptibility to maraviroc, the various phenotypic algorithms failed to predict CXCR4 usage based on the V3 Env sequences of group O HIV-1 isolates. Decreased sensitivity of group O HIV-1 to integrase or NNRTIs had no relation to replicative fitness. Group O HIV-1 isolates were 10-fold less sensitive to EVG inhibition than group M HIV-1. These findings suggest that in regions where HIV-1 group O is endemic, first line treatment regimens combining two NRTIs with RAL may provide more sustained virologic responses than the standard regimens involving an NNRTI or protease inhibitors.
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Affiliation(s)
- Denis M. Tebit
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Hamish Patel
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Annette Ratcliff
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
| | | | - Joseph Liu
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
| | - Crystal Carpenter
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
| | | | - Eric J. Arts
- Division of Infectious Diseases, Case Western Reserve University, Cleveland, Ohio
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16
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Haleyur Giri Setty MK, Liu J, Mahtani P, Zhang P, Du B, Ragupathy V, Devadas K, Hewlett IK. Novel Time-Resolved Fluorescence Europium Nanoparticle Immunoassay for Detection of Human Immunodeficiency Virus-1 Group O Viruses Using Microplate and Microchip Platforms. AIDS Res Hum Retroviruses 2016; 32:612-9. [PMID: 26978478 DOI: 10.1089/aid.2014.0351] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Accurate detection and quantification of HIV-1 group O viruses have been challenging for currently available HIV assays. We have developed a novel time-resolved fluorescence (TRF) europium nanoparticle immunoassay for HIV-1 group O detection using a conventional microplate enzyme-linked immunosorbent assay (ELISA) and a microchip platform. We screened several antibodies for optimal reactivity with several HIV-1 group O strains and identified antibodies that can detect all the strains of HIV-1 group O that were available for testing. The antibodies were used to develop a conventional ELISA format assay and an in-house developed europium nanoparticle-based assay for sensitivity. The method was evaluated on both microwell plate and microchip platforms. We identified two specific and sensitive antibodies among the six we screened. The antibodies, C65691 and ANT-152, were able to quantify 15 and detect all 17 group O viruses, respectively, as they were broadly cross-reactive with all HIV-1 group O strains and yielded better signals compared with other antibodies. We have developed a sensitive assay that reflects the actual viral load in group O samples by using an appropriate combination of p24 antibodies that enhance group O detection and a highly sensitive TRF-based europium nanoparticle for detection. The combination of ANT-152 and C65690M in the ratio 3:1 was able to give significantly higher signals in our europium-based assay compared with using any single antibody.
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Affiliation(s)
| | - Jikun Liu
- Laboratory of Molecular Virology, CBER, FDA, Silver Spring, Maryland
| | - Prerna Mahtani
- Laboratory of Molecular Virology, CBER, FDA, Silver Spring, Maryland
| | - Panhe Zhang
- Laboratory of Molecular Virology, CBER, FDA, Silver Spring, Maryland
| | - Bingchen Du
- Laboratory of Molecular Virology, CBER, FDA, Silver Spring, Maryland
| | | | | | - Indira K. Hewlett
- Laboratory of Molecular Virology, CBER, FDA, Silver Spring, Maryland
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17
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A Multiplex PCR Approach for Detecting Dual Infections and Recombinants Involving Major HIV Variants. J Clin Microbiol 2016; 54:1282-8. [PMID: 26912747 DOI: 10.1128/jcm.03222-15] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Accepted: 02/16/2016] [Indexed: 02/07/2023] Open
Abstract
The cocirculation of different HIV types and groups can lead to dual infections and recombinants, which hinder diagnosis and therapeutic management. We designed two multiplex PCRs (mPCRs) coupled with capillary electrophoresis to facilitate the detection of such infections. The first, MMO2, targets three variants (HIV-1/M, HIV-1/O, and HIV-2), and the second, MMO, targets HIV-1/M and HIV-1/O. These mPCRs were validated on DNA and RNA extracts from 19 HIV-1/M, 12 HIV-1/O, and 13 HIV-2 cultures and from mixtures simulating dual infections. They were then assessed with DNA and RNA extracts from samples of 47 clinical monoinfections and HIV-1/M+O dual infections or infections with HIV-1/MO recombinants. Both mPCRs had excellent specificity. Sensitivities ranged from 80 to 100% for in vitro samples and from 58 to 100% for clinical samples, with the results obtained depending on the material used and the region of the genome concerned. Sensitivity was generally lower for DNA than for RNA and for amplifications of the integrase and matrix regions. In terms of global detection (at least one target gene for each strain), both mPCRs yielded a detection rate of 100% for in vitro samples. MMO2 detected 100% of the clinical strains from DNA and 97% from RNA, whereas MMO detected 100% of the strains from both materials. Thus, for in vitro and clinical samples, MMO2 was a useful tool for detecting dual infections with HIV-1 and HIV-2 (referred to as HIV-1+HIV-2) and HIV-1/M+O, and MMO was useful for detecting both MO dual infections and MO mosaic patterns.
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18
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Abstract
OBJECTIVE Despite the genetic divergence between HIV-1 groups M and O, HIV-1 M/O intergroup recombinants were reported. Actually, there is no data on the transmissibility of such recombinant forms. During a surveillance of HIV genetic diversity in Cameroon, we investigated the possible direct transmission of an HIV-1 M/O recombinant virus in an HIV-infected couple. METHODS Consecutive samples obtained from the couple were analysed for detection of dual HIV-1 groups M and O infections, and HIV-1 M/O recombinant forms. Analyses were performed using a serological and molecular algorithm based on HIV serotyping and group-specific PCRs targeting the polymerase and envelope genes. Pattern characterization of the strains found in both patients was based on complete genome sequencing. Phylogenetic and similarity profile analyses were performed to investigate the genetic relationship between viruses from both spouses and the previously described recombinant forms. RESULTS The sero-molecular algorithm data showed a group O serotype confirmed by molecular analysis in the envelope regions, whereas molecular tests identified HIV-1 group M in the polymerase. Phylogenetic analyses and similarity profiles of the full-length genome sequences showed that both spouses were infected with a unique recombinant virus having two recombination breakpoints in the vpr gene and LTR region. No phylogenetic link was found with the previous M/O recombinants. CONCLUSION We provide, for the first time, molecular evidence of direct transmission of an HIV-1 M/O recombinant, highlighting the potential spread of these divergent viruses. The importance of HIV-1 recombination on genetic evolution and public health when implying divergent strains as group O has to be carefully considered.
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19
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Villabona-Arenas CJ, Domyeum J, Mouacha F, Butel C, Delaporte E, Peeters M, Mpoudi-Ngole E, Aghokeng AF. HIV-1 group O infection in Cameroon from 2006 to 2013: Prevalence, genetic diversity, evolution and public health challenges. INFECTION GENETICS AND EVOLUTION 2015; 36:210-216. [PMID: 26371064 DOI: 10.1016/j.meegid.2015.09.006] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/27/2015] [Revised: 09/02/2015] [Accepted: 09/03/2015] [Indexed: 11/25/2022]
Abstract
The human immunodeficiency virus, HIV, is characterized by a tremendously high genetic diversity, leading to the currently known circulating HIV types, groups, subtypes, and recombinant forms. HIV-1 group O is one of the most diverse forms of HIV-1 and has been so far related to Cameroon or individuals originating from Cameroon. In this study, we investigated in Cameroon, the evolution of this viral group from 2006 to 2013, in terms of prevalence, genetic diversity and public health implications. Our results confirmed the predominance of HIV-1 group M (98.5%), a very low prevalence (<0.02%) for HIV-1 group N and P, and HIV-2 in this country. HIV-1 group O was found at around 0.6% (95% confidence interval: 0.4-0.8%), indicating that the frequency of this virus in Cameroon has remained stable over the last decades. However, we found an extensive high genetic diversity within this HIV-1 group, that resulted from previous steady increase on the effective number of HIV-1 group O infections through time, and the current distribution of the circulating viral strains still does not allow classification as subtypes. The frequency of dual infections with HIV-1 group M and group O was 0.8% (95% confidence interval: 0.6-1.0%), but we found no recombinant forms in co-infected patients. Natural resistance to integrase inhibitors was not identified, although we found several mutations considered as natural polymorphisms. Our study shows that infections with HIV-1 group O can be adequately managed in countries where the virus circulates, but this complex virus still represents a challenge for diagnostics and monitoring strategies.
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Affiliation(s)
- Christian Julian Villabona-Arenas
- Unité Mixte International 233, Institut de Recherche pour le Développement, INSERM U1175, and University of Montpellier, Montpellier, France; Computational Biology Institute, Montpellier, France.
| | - Jenny Domyeum
- Centre de Recherche sur les Maladies Emergentes et Réémergentes - CREMER, Laboratoire de Virologie IMPM-IRD, Yaoundé, Cameroon.
| | - Fatima Mouacha
- Unité Mixte International 233, Institut de Recherche pour le Développement, INSERM U1175, and University of Montpellier, Montpellier, France.
| | - Christelle Butel
- Unité Mixte International 233, Institut de Recherche pour le Développement, INSERM U1175, and University of Montpellier, Montpellier, France.
| | - Eric Delaporte
- Unité Mixte International 233, Institut de Recherche pour le Développement, INSERM U1175, and University of Montpellier, Montpellier, France.
| | - Martine Peeters
- Unité Mixte International 233, Institut de Recherche pour le Développement, INSERM U1175, and University of Montpellier, Montpellier, France.
| | - Eitel Mpoudi-Ngole
- Centre de Recherche sur les Maladies Emergentes et Réémergentes - CREMER, Laboratoire de Virologie IMPM-IRD, Yaoundé, Cameroon.
| | - Avelin Fobang Aghokeng
- Unité Mixte International 233, Institut de Recherche pour le Développement, INSERM U1175, and University of Montpellier, Montpellier, France; Centre de Recherche sur les Maladies Emergentes et Réémergentes - CREMER, Laboratoire de Virologie IMPM-IRD, Yaoundé, Cameroon.
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20
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Alessandri-Gradt E, Morgand M, Delaugerre C, Peytavin G, Sellier P, Simon F, Plantier JC. HIV-1 group O resistance pathway with raltegravir is similar to HIV-1 group M. AIDS 2015; 29:1271-3. [PMID: 26035328 DOI: 10.1097/qad.0000000000000703] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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21
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Diallo K, Zheng DP, Rottinghaus EK, Bassey O, Yang C. Viral Genetic Diversity and Polymorphisms in a Cohort of HIV-1-Infected Patients Eligible for Initiation of Antiretroviral Therapy in Abuja, Nigeria. AIDS Res Hum Retroviruses 2015; 31:564-75. [PMID: 25582324 DOI: 10.1089/aid.2014.0168] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Studying the genetic diversity and natural polymorphisms of HIV-1 would benefit our understanding of HIV drug resistance (HIVDR) development and predict treatment outcomes. In this study, we have characterized the HIV-1 genetic diversity and natural polymorphisms at the 5' region of the pol gene encompassing the protease (PR) and reverse transcriptase (RT) from 271 plasma specimens collected in 2008 from HIV-1-infected patients who were eligible for initiating antiretroviral therapy in Abuja (Nigeria). The analysis indicated that the predominant subtype was subtype G (31.0%), followed by CRF02-AG (19.2 %), CRF43-02G (18.5%), and A/CRF36-cpx (11.4%); the remaining (19.9%) were other subtypes and circulating (CRF) and unique (URF) recombinant forms. Recombinant viruses (68.6%) were the major viral strains in the region. Eighty-four subtype G sequences were further mainly classified into two major and two minor clusters; sequences in the two major clusters were closely related to the HIV-1 strains in two of the three major subtype G clusters detected worldwide. Those in the two minor clusters appear to be new subtype G strains circulating only in Abuja. The pretreatment DR prevalence was <3%; however, numerous natural polymorphisms were present. Eleven polymorphic mutations (G16E, K20I, L23P, E35D, M36I, N37D/S/T, R57K, L63P, and V82I) were detected in the PR that were subtype or CRF specific while only three mutations (D123N, I135T, and I135V) were identified in the RT. Overall, this study indicates an evolving HIV-1 epidemic in Abuja with recombinant viruses becoming the dominant strains and the emergence of new subtype G strains; pretreatment HIVDR was low and the occurrence of natural polymorphism in the PR region was subtype or CRF dependent.
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Affiliation(s)
- Karidia Diallo
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Du-Ping Zheng
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Erin K. Rottinghaus
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Orji Bassey
- Centers for Disease Control and Prevention, Abuja, Nigeria
| | - Chunfu Yang
- International Laboratory Branch, Division of Global HIV/AIDS, Center for Global Health, Centers for Disease Control and Prevention, Atlanta, Georgia
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Mori F, Cianferoni A, Barni S, Pucci N, Rossi ME, Novembre E. Amoxicillin allergy in children: five-day drug provocation test in the diagnosis of nonimmediate reactions. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY-IN PRACTICE 2015; 3:375-80.e1. [PMID: 25609343 DOI: 10.1016/j.jaip.2014.11.001] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Revised: 10/30/2014] [Accepted: 11/03/2014] [Indexed: 01/12/2023]
Abstract
BACKGROUND The drug provocation test (DPT) is the gold standard to rule out drug hypersensitivity. There are standardized DPT protocols to diagnose immediate reactions to drugs, but not for nonimmediate reactions. OBJECTIVE The aim of this study was to show the sensitivity and specificity of an allergy work-up that included a 5-day DPT in children with histories of nonimmediate reactions to amoxicillin through focusing on a pediatric population with histories of immediate and nonimmediate reactions to amoxicillin. METHODS Two hundred consecutive patients with histories of amoxicillin reactions referred to the Allergy Unit of Anna Meyer Children's Hospital for suspected drug allergy from 2008 to 2011 underwent in vivo tests with the culprit drug according to European Academy of Allergy and Clinical Immunology guidelines. Moreover, most of those children, regardless of the skin tests results, were challenged with amoxicillin for a total of 5 days. RESULTS In 4 years, 200 patients were evaluated for a history of drug hypersensitivity to amoxicillin. The majority of patients (76%) had a history of mild nonimmediate reactions. All 200 patients underwent skin tests, and 9 of 200 tested positive. A total of 177 DPTs were performed with amoxicillin for 5 days in each child. Diagnosis of amoxicillin allergy was confirmed by a DPT in 17 patients (9.6%); 14/17 had history of nonimmediate reactions; 4/14 (26.6%) reacted on day 5. CONCLUSION According to our results, a long-term DPT protocol increases the sensitivity of the allergy work-up, and it should be recommended for patients with a history of amoxicillin nonimmediate reaction.
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Affiliation(s)
- Francesca Mori
- Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy.
| | | | - Simona Barni
- Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Neri Pucci
- Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Maria Elisabetta Rossi
- Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
| | - Elio Novembre
- Allergy Unit, Department of Pediatric, Anna Meyer Children's University Hospital, Florence, Italy
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Singh K, Flores JA, Kirby KA, Neogi U, Sonnerborg A, Hachiya A, Das K, Arnold E, McArthur C, Parniak M, Sarafianos SG. Drug resistance in non-B subtype HIV-1: impact of HIV-1 reverse transcriptase inhibitors. Viruses 2014; 6:3535-62. [PMID: 25254383 PMCID: PMC4189038 DOI: 10.3390/v6093535] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2014] [Revised: 09/09/2014] [Accepted: 09/09/2014] [Indexed: 01/20/2023] Open
Abstract
Human immunodeficiency virus (HIV) causes approximately 2.5 million new infections every year, and nearly 1.6 million patients succumb to HIV each year. Several factors, including cross-species transmission and error-prone replication have resulted in extraordinary genetic diversity of HIV groups. One of these groups, known as group M (main) contains nine subtypes (A-D, F-H and J-K) and causes ~95% of all HIV infections. Most reported data on susceptibility and resistance to anti-HIV therapies are from subtype B HIV infections, which are prevalent in developed countries but account for only ~12% of all global HIV infections, whereas non-B subtype HIV infections that account for ~88% of all HIV infections are prevalent primarily in low and middle-income countries. Although the treatments for subtype B infections are generally effective against non-B subtype infections, there are differences in response to therapies. Here, we review how polymorphisms, transmission efficiency of drug-resistant strains, and differences in genetic barrier for drug resistance can differentially alter the response to reverse transcriptase-targeting therapies in various subtypes.
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Affiliation(s)
- Kamalendra Singh
- Christopher Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.
| | - Jacqueline A Flores
- Christopher Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.
| | - Karen A Kirby
- Christopher Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.
| | - Ujjwal Neogi
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm 141 86, Sweden.
| | - Anders Sonnerborg
- Division of Clinical Microbiology, Department of Laboratory Medicine, Karolinska Institute, Stockholm 141 86, Sweden.
| | - Atsuko Hachiya
- Clinical Research Center, Department of Infectious Diseases and Immunology, National Hospital Organization, Nagoya Medical Center, Nagoya 460-0001, Japan.
| | - Kalyan Das
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ 08854, USA.
| | - Eddy Arnold
- Center for Advanced Biotechnology and Medicine, Rutgers University, Piscataway, NJ 08854, USA.
| | - Carole McArthur
- Department of Oral and Craniofacial Science , School of Dentistry, University of Missouri, Kansas City, MO 64108, USA.
| | - Michael Parniak
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA.
| | - Stefan G Sarafianos
- Christopher Bond Life Sciences Center, University of Missouri, Columbia, MO 65211, USA.
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24
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Muniz CP, Soares MA, Santos AF. Early selection of resistance-associated mutations in HIV-1 RT C-terminal domains across different subtypes: role of the genetic barrier to resistance. J Antimicrob Chemother 2014; 69:2741-5. [DOI: 10.1093/jac/dku214] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Megens S, Laethem KV. HIV-1 genetic variation and drug resistance development. Expert Rev Anti Infect Ther 2014; 11:1159-78. [PMID: 24151833 DOI: 10.1586/14787210.2013.844649] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Up until 10 years ago, basic and clinical HIV-1 research was mainly performed on HIV-1 subtype B that predominated in resource-rich settings. Over the past decade, HIV-1 care and therapy has been scaled up substantially in Latin America, Africa and Asia. These regions are largely dominated by non-B subtype infections, and especially the African continent is affected by the HIV pandemic. Insight on the potency of antiviral drugs and regimens as well as on the emergence of drug resistance in non-B subtypes was lacking triggering research in this field, also partly driven by the introduction and spreading of HIV-1 non-B subtypes in Europe. The scope of this article was to review and discuss the state-of-the-art on the impact of HIV-1 genetic variation on the in vitro activity of antiviral drugs and in vivo response to antiviral therapy; as well as on the in vitro and in vivo emergence of drug resistance.
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Affiliation(s)
- Sarah Megens
- Department Microbiology and Immunology, Rega Institute for Medical Research, Clinical and Epidemiological Virology, KU Leuven, Minderbroedersstraat 10, B-3000 Leuven, Belgium
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Buckheit RW, Sexauer SB, Sedaghat AR, Wilke CO, Laeyendecker O, Basseth CR, Blankson JN. Long-term control of viral replication in a Group O, human immunodeficiency virus type 1-infected individual. AIDS Res Hum Retroviruses 2014; 30:511-3. [PMID: 24798496 DOI: 10.1089/aid.2014.0054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Robert W. Buckheit
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Stephen B. Sexauer
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Ahmad R. Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Harvard Medical School, Boston, Massachusetts
| | - Claus O. Wilke
- Section of Integrative Biology, Center for Computational Biology and Bioinformatics, Austin, Texas
- Institute for Cell and Molecular Biology, University of Texas at Austin, Austin, Texas
| | - Oliver Laeyendecker
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
- Division of Intramural Research, NIAID, NIH, Baltimore, Maryland
| | - Christie R. Basseth
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Joel N. Blankson
- Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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27
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Demoly P, Adkinson NF, Brockow K, Castells M, Chiriac AM, Greenberger PA, Khan DA, Lang DM, Park HS, Pichler W, Sanchez-Borges M, Shiohara T, Thong BYH. International Consensus on drug allergy. Allergy 2014; 69:420-37. [PMID: 24697291 DOI: 10.1111/all.12350] [Citation(s) in RCA: 612] [Impact Index Per Article: 61.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/18/2013] [Indexed: 01/11/2023]
Abstract
When drug reactions resembling allergy occur, they are called drug hypersensitivity reactions (DHRs) before showing the evidence of either drug-specific antibodies or T cells. DHRs may be allergic or nonallergic in nature, with drug allergies being immunologically mediated DHRs. These reactions are typically unpredictable. They can be life-threatening, may require or prolong hospitalization, and may necessitate changes in subsequent therapy. Both underdiagnosis (due to under-reporting) and overdiagnosis (due to an overuse of the term ‘allergy’) are common. A definitive diagnosis of such reactions is required in order to institute adequate treatment options and proper preventive measures. Misclassification based solely on the DHR history without further testing may affect treatment options, result in adverse consequences, and lead to the use of more-expensive or less-effective drugs, in contrast to patients who had undergone a complete drug allergy workup. Several guidelines and/or consensus documents on general or specific drug class-induced DHRs are available to support the medical decision process. The use of standardized systematic approaches for the diagnosis and management of DHRs carries the potential to improve outcomes and should thus be disseminated and implemented. Consequently, the International Collaboration in Asthma, Allergy and Immunology (iCAALL), formed by the European Academy of Allergy and Clinical Immunology (EAACI), the American Academy of Allergy, Asthma and Immunology (AAAAI), the American College of Allergy, Asthma and Immunology (ACAAI), and the World Allergy Organization (WAO), has decided to issue an International CONsensus (ICON) on drug allergy. The purpose of this document is to highlight the key messages that are common to many of the existing guidelines, while critically reviewing and commenting on any differences and deficiencies of evidence, thus providing a comprehensive reference document for the diagnosis and management of DHRs.
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Affiliation(s)
- P. Demoly
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, France and Sorbonne Universités; Paris France
| | - N. F. Adkinson
- Division of Allergy and Clinical Immunology; The Johns Hopkins Asthma and Allergy Center; The Hopkins Bayview Medical Campus; Baltimore MD USA
| | - K. Brockow
- Department of Dermatology and Allergology Biederstein; Technische Universität München; Munich Germany
| | - M. Castells
- Division of Rheumatology, Allergy and Immunology; Department of Medicine; Brigham and Women's Hospital; Boston MA
| | - A. M. Chiriac
- Département de Pneumologie et Addictologie; Hôpital Arnaud de Villeneuve, University Hospital of Montpellier, France and Sorbonne Universités; Paris France
| | - P. A. Greenberger
- Division of Allergy-Immunology; Northwestern University Feinberg School of Medicine; Chicago IL
| | - D. A. Khan
- Division of Allergy & Immunology; University of Texas Southwestern Medical Center; Dallas TX
| | - D. M. Lang
- Department of Allergy/Immunology; Respiratory Institute; Cleveland Clinic Foundation; Cleveland OH USA
| | - H.-S. Park
- Department of Allergy and Clinical Immunology; Ajou University School of Medicine; Suwon Korea
| | - W. Pichler
- Division of Allergology; Department of Rheumatology and Allergology/Clinical Immunology; Inselspital, University of Bern; Bern Switzerland
| | - M. Sanchez-Borges
- Allergy and Clinical Immunology Department; Centro Medico Docente La Trinidad; Caracas Venezuela
| | - T. Shiohara
- Department of Dermatology; Kyorin University School of Medicine; Tokyo Japan
| | - B. Y.-H. Thong
- Department of Rheumatology, Allergy and Immunology; Tan Tock Seng Hospital; Singapore
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Abstract
The AIDS pandemic that started in the early 1980s is due to human immunodeficiency virus type 1 (HIV-1) group M (HIV-M), but apart from this major group, many divergent variants have been described (HIV-1 groups N, O, and P and HIV-2). The four HIV-1 groups arose from independent cross-species transmission of the simian immunodeficiency viruses (SIVs) SIVcpz, infecting chimpanzees, and SIVgor, infecting gorillas. This, together with human adaptation, accounts for their genomic, phylogenetic, and virological specificities. Nevertheless, the natural course of non-M HIV infection seems similar to that of HIV-M. The virological monitoring of infected patients is now possible with commercial kits, but their therapeutic management remains complex. All non-M variants were principally described for patients linked to Cameroon, where HIV-O accounts for 1% of all HIV infections; only 15 cases of HIV-N infection and 2 HIV-P infections have been reported. Despite improvements in our knowledge, many fascinating questions remain concerning the origin, genetic evolution, and slow spread of these variants. Other variants may already exist or may arise in the future, calling for close surveillance. This review provides a comprehensive, up-to-date summary of the current knowledge on these pathogens, including the historical background of their discovery; the latest advances in the comprehension of their origin and spread; and clinical, therapeutic, and laboratory aspects that may be useful for the management and the treatment of patients infected with these divergent viruses.
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Gupta RK, Van de Vijver DAMC, Manicklal S, Wainberg MA. Evolving uses of oral reverse transcriptase inhibitors in the HIV-1 epidemic: from treatment to prevention. Retrovirology 2013; 10:82. [PMID: 23902855 PMCID: PMC3733946 DOI: 10.1186/1742-4690-10-82] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 07/26/2013] [Indexed: 12/24/2022] Open
Abstract
The HIV epidemic continues unabated, with no highly effective vaccine and no cure. Each new infection has significant economic, social and human costs and prevention efforts are now as great a priority as global antiretroviral therapy (ART) scale up. Reverse transcriptase inhibitors, the first licensed class of ART, have been at the forefront of treatment and prevention of mother to child transmission over the past two decades. Now, their use in adult prevention is being extensively investigated. We describe two approaches: treatment as prevention (TasP) - the use of combination ART (2NRTI and 1NNRTI) following HIV diagnosis to limit transmission and pre-exposure prophylaxis (PrEP) –the use of single or dual oral agents prior to sexual exposure. Prevention of mother-to-child transmission using NRTI has been highly successful, though does not involve sustained use of NRTI to limit transmission. Despite theoretical and preliminary support for TasP and PrEP, data thus far indicate that adherence, retention in care and late diagnosis are the major barriers to their successful, sustained implementation. Future advances in drug technologies will be needed to overcome the issue of drug adherence, through development of drugs that involve both less frequent dosing as well as reduced toxicity, possibly through specific targeting of infected cells.
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Affiliation(s)
- Ravindra K Gupta
- Division of Infection and Immunity, University College, 90 Gower St, London WC1E 6BT, UK.
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30
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Liégeois F, Boué V, Butel C, Mouinga-Ondémé A, Sica J, Zamba C, Peeters M, Delaporte E, Rouet F. HIV type-1 group O infection in Gabon: low prevalence rate but circulation of genetically diverse and drug-resistant HIV type-1 group O strains. AIDS Res Hum Retroviruses 2013; 29:1085-90. [PMID: 23409798 DOI: 10.1089/aid.2012.0375] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
The goals of this study conducted in Gabon were to determine the prevalence rate of HIV-1 group O (HIV-1/O) infections and to characterize the genetic diversity of HIV-1/O strains as well as implications on antiretroviral (ARV) drug resistance. During 2010-2011, 1,176 samples from HIV-positive subjects were tested at the CIRMF (Centre International de Recherches Médicales de Franceville) retrovirology laboratory using an in-house serotyping assay. Plasma HIV-1/O RNA viral loads (VL) were determined using the Abbott RealTime HIV-1 assay. After full genome sequencing, drug resistance patterns were analyzed using two different algorithms (Agence Nationale de Recherches sur le SIDA et les hépatites virales and Stanford). Overall, four subjects (0.34%) were diagnosed as HIV-1/O infected. One subject, untreated by ARVs, died 2 months after HIV-1/O diagnosis. One was lost to follow-up. Two additional patients, treated with nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens, showed CD4 counts <200/mm(3) and VL results of 101,000 and 10,050 cp/ml. After full-length genome sequencing of these two strains, we found a wide range of natural polymorphism in the protease (≥15 substitutions) and gp41 (N42D mutation) genes, as well as in the gag and gag-pol cleavage sites. No resistance mutation was detected in the integrase gene. These two strains harbored the Y181C mutation making them resistant to NNRTIs. M41L, M184V, and T215Y mutations were also found for one strain, making it resistant to all NRTIs by the Stanford algorithm. Even if HIV-1/O infection is low in Gabon, an accurate diagnosis and a reliable virological follow-up are required in Central Africa to optimize ARV treatments of HIV-1/O-infected patients.
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Affiliation(s)
- Florian Liégeois
- Laboratoire de Rétrovirologie, CIRMF (Centre International de Recherches Médicales de Franceville), Franceville, Gabon
- UMI 233 “Trans VIH MI” (Transitions épidémiologiques, recherches translationnelles appliquées au VIH et aux Maladies Infectieuses), Institut de Recherche pour le Développement (IRD), and Université de Montpellier 1 (UM1), Montpellier, France
| | - Vanina Boué
- Laboratoire de Rétrovirologie, CIRMF (Centre International de Recherches Médicales de Franceville), Franceville, Gabon
| | - Christelle Butel
- UMI 233 “Trans VIH MI” (Transitions épidémiologiques, recherches translationnelles appliquées au VIH et aux Maladies Infectieuses), Institut de Recherche pour le Développement (IRD), and Université de Montpellier 1 (UM1), Montpellier, France
| | - Augustin Mouinga-Ondémé
- Laboratoire de Rétrovirologie, CIRMF (Centre International de Recherches Médicales de Franceville), Franceville, Gabon
| | - Jeanne Sica
- Centre de Traitement Ambulatoire (CTA), Franceville, Gabon
| | - Chantal Zamba
- Centre de Traitement Ambulatoire (CTA), Libreville, Gabon
| | - Martine Peeters
- UMI 233 “Trans VIH MI” (Transitions épidémiologiques, recherches translationnelles appliquées au VIH et aux Maladies Infectieuses), Institut de Recherche pour le Développement (IRD), and Université de Montpellier 1 (UM1), Montpellier, France
| | - Eric Delaporte
- UMI 233 “Trans VIH MI” (Transitions épidémiologiques, recherches translationnelles appliquées au VIH et aux Maladies Infectieuses), Institut de Recherche pour le Développement (IRD), and Université de Montpellier 1 (UM1), Montpellier, France
| | - François Rouet
- Laboratoire de Rétrovirologie, CIRMF (Centre International de Recherches Médicales de Franceville), Franceville, Gabon
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Aghokeng AF, Kouanfack C, Peeters M, Mpoudi-Ngole E, Delaporte E. Successful integrase inhibitor-based highly active antiretroviral therapy for a multidrug-class-resistant HIV type 1 group O-infected patient in Cameroon. AIDS Res Hum Retroviruses 2013; 29:1-3. [PMID: 22889147 DOI: 10.1089/aid.2012.0196] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Avelin F. Aghokeng
- Virology Laboratory CREMER/IMPM/IRD, Yaoundé, Cameroon
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
| | | | - Martine Peeters
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
| | | | - Eric Delaporte
- UMI 233 TransVIHMI, Institut de Recherche pour le Développement (IRD), University Montpellier 1, Montpellier, France
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Raltegravir-based regimens are effective in HIV-1 group O-infected patients. J Acquir Immune Defic Syndr 2012; 61:e1-3. [PMID: 22918125 DOI: 10.1097/qai.0b013e31826327c4] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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The Impact of HIV Genetic Polymorphisms and Subtype Differences on the Occurrence of Resistance to Antiretroviral Drugs. Mol Biol Int 2012; 2012:256982. [PMID: 22792462 PMCID: PMC3390109 DOI: 10.1155/2012/256982] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2012] [Accepted: 04/12/2012] [Indexed: 12/20/2022] Open
Abstract
The vast majority of reports on drug resistance deal with subtype B infections in developed countries, and this is largely due to historical delays in access to antiretroviral therapy (ART) on a worldwide basis. This notwithstanding the concept that naturally occurring polymorphisms among different non-B subtypes can affect HIV-1 susceptibility to antiretroviral drugs (ARVs) is supported by both enzymatic and virological data. These findings suggest that such polymorphisms can affect both the magnitude of resistance conferred by some major mutations as well as the propensity to acquire certain resistance mutations, even though such differences are sometimes difficult to demonstrate in phenotypic assays. It is mandatory that tools are optimized to assure accurate measurements of drug susceptibility in non-B subtypes and to recognize that each subtype may have a distinct resistance profile and that differences in resistance pathways may also impact on cross-resistance and the choice of regimens to be used in second-line therapy. Although responsiveness to first-line therapy should not theoretically be affected by considerations of viral subtype and drug resistance, well-designed long-term longitudinal studies involving patients infected by viruses of different subtypes should be carried out.
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Oliveira V, Bártolo I, Borrego P, Rocha C, Valadas E, Barreto J, Almeida E, Antunes F, Taveira N. Genetic diversity and drug resistance profiles in HIV type 1- and HIV type 2-infected patients from Cape Verde Islands. AIDS Res Hum Retroviruses 2012; 28:510-22. [PMID: 21902592 DOI: 10.1089/aid.2011.0174] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Our aim was to characterize for the first time the genetic diversity of HIV in Cape Verde Islands as well as the drug resistance profiles in treated and untreated patients. Blood specimens were collected from 41 HIV-1 and 14 HIV-2 patients living in Santiago Island. Half of the patients were on antiretroviral treatment (ART). Pol and env gene sequences were obtained using in-house methods. Phylogenetic analysis was used for viral subtyping and the Stanford Algorithm was used for resistance genotyping. For HIV-1, the amplification of pol and env was possible in 27 patients (66%). HIV-1 patients were infected with subtypes G (13, 48%), B (2, 7%), F1 (2, 7%), and CRF02_AG (2, 7%), and complex recombinant forms including a new C/G variant (n=8, 30%). Drug resistance mutations were detected in the PR and RT of three (10%) treated patients. M41L and K103N transmitted drug resistance mutations were found in 2 of 17 (12%) untreated patients. All 14 HIV-2 isolates belonged to group A. The origin of 12 strains was impossible to determine whereas two strains were closely related to the historic ROD strain. In conclusion, in Cape Verde there is a long-standing HIV-2 epidemic rooted in ROD-like strains and a more recent epidemic of unknown origin. The HIV-1 epidemic is caused by multiple subtypes and complex recombinant forms. Drug resistance HIV-1 strains are present at moderate levels in both treated and untreated patients. Close surveillance in these two populations is crucial to prevent further transmission of drug-resistant strains.
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Affiliation(s)
- Vânia Oliveira
- Laboratório de Hemato-Oncologia, Instituto Português de Oncologia, Lisbon, Portugal
- Unidade dos Retrovírus e Infecções Associadas, Centro de Patogénese Molecular, Faculdade de Farmácia de Lisboa, Lisbon, Portugal
| | - Inês Bártolo
- Unidade dos Retrovírus e Infecções Associadas, Centro de Patogénese Molecular, Faculdade de Farmácia de Lisboa, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal
| | - Pedro Borrego
- Unidade dos Retrovírus e Infecções Associadas, Centro de Patogénese Molecular, Faculdade de Farmácia de Lisboa, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal
| | - Cheila Rocha
- Unidade dos Retrovírus e Infecções Associadas, Centro de Patogénese Molecular, Faculdade de Farmácia de Lisboa, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal
| | - Emília Valadas
- Clínica Universitária de Doenças Infecciosas/Serviço de Doenças Infecciosas, Faculdade de Medicina de Lisboa/Hospital de Santa Maria, Lisbon, Portugal
| | - Jorge Barreto
- Hospital Dr. Agostinho Neto, Delegacia de Saúde, Cidade da Praia, Cabo Verde
| | - Elsa Almeida
- Hospital Dr. Agostinho Neto, Delegacia de Saúde, Cidade da Praia, Cabo Verde
| | - Francisco Antunes
- Clínica Universitária de Doenças Infecciosas/Serviço de Doenças Infecciosas, Faculdade de Medicina de Lisboa/Hospital de Santa Maria, Lisbon, Portugal
| | - Nuno Taveira
- Unidade dos Retrovírus e Infecções Associadas, Centro de Patogénese Molecular, Faculdade de Farmácia de Lisboa, Lisbon, Portugal
- Centro de Investigação Interdisciplinar Egas Moniz (CiiEM), Instituto Superior de Ciências da Saúde Egas Moniz, Monte de Caparica, Portugal
- Instituto de Medicina Molecular, Faculdade de Medicina da Universidade de Lisboa, Lisbon, Portugal
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A new real-time quantitative PCR for diagnosis and monitoring of HIV-1 group O infection. J Clin Microbiol 2011; 50:831-6. [PMID: 22170927 DOI: 10.1128/jcm.05669-11] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The correct diagnosis and monitoring of HIV-1 group O (HIV-O) infection are essential for appropriate patient management, for the prevention of mother-to-child transmission, and for the detection of dual HIV-M/HIV-O infections. HIV-O RNA quantification is currently possible with two commercial kits (from Abbott and Roche), which quantify HIV-M and HIV-O strains indifferently; therefore, they cannot be used for the specific identification of HIV-O infection. We designed a new real-time quantitative reverse transcription PCR (RT-qPCR assay) (INT-O), which we compared with our previous version, LTR-O, and with the Abbott RealTime HIV-1 kit. Specificity was assessed with 27 HIV-1 group M strains and the prototype strain of group P. Clinical performances were analyzed by using 198 stored plasma samples, representative of HIV-O genetic diversity. Analytical sensitivity, repeatability, and reproducibility were also determined. The detection limit of the INT-O assay was 40 copies/ml, and its specificity was 100%. The repeatability and reproducibility were excellent. Analysis of clinical samples showed a good correlation between the INT-O and LTR-O assays (r = 0.8240), with an improvement of analytical sensitivity. A good correlation was also obtained between the INT-O and Abbott assays (r = 0.8599) but with significantly higher values (0.19 logs) for the INT-O method, due to marked underquantifications for some patients. These results showed that HIV-O genetic diversity still has an impact on RNA quantification. The new assay, INT-O, allows both the specific diagnosis of HIV-O infection and the quantification of diverse HIV-O strains. Its detection limit is equivalent to that of commercial kits. This assay is cheap and suitable for use in areas in which strains of HIV-1 groups M and O cocirculate.
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Affiliation(s)
- Mark A Wainberg
- McGill University AIDS Centre, Lady Davis Institute, Jewish General Hospital, Montreal, QC H3T 1E2, Canada.
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Impact of HIV-1 group O genetic diversity on genotypic resistance interpretation by algorithms designed for HIV-1 group M. J Acquir Immune Defic Syndr 2011; 56:139-45. [PMID: 21233638 DOI: 10.1097/qai.0b013e318201a904] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND HIV-1 group O (HIV-O) is characterized by a high genetic divergence from HIV-1 group M viruses. Little is known about the therapeutic impact of this diversity. The aim of this study was to assess in a large series of samples (1) the genotypic impact of natural polymorphism of the HIV-O reverse transcriptase and protease genes; and (2) the predictive value of resistance interpretation algorithms developed for HIV-1 group M when used for highly mutated HIV-O viruses. METHODS Sixty-eight antiretroviral-naive and 9 highly antiretroviral-experienced HIV-O-infected patients were included. The viruses were sequenced and resistance-associated mutations were identified using 3 different algorithms (Agence Nationale de Recherches sur le SIDA et les hépatites virales, Rega, Stanford). RESULTS All HIV-O samples naturally exhibited the A98G and V179E resistance mutations in the reverse transcriptase region; 54% of samples presented the Y181C mutation, conferring resistance to nonnucleoside reverse transcriptase inhibitors. Twelve minor resistance mutations, present in more than 75% of the protease sequences, led to the different algorithms giving discrepant results for nelfinavir and saquinavir susceptibility. A marked virological response was observed in 8 of the 9 antiretroviral-experienced patients, despite the prediction of limited activity of the combination for 5 to 8 patients according to the algorithm used. CONCLUSIONS The high level of natural polymorphism in HIV-O genes, and the important discrepancies between genotypic resistance interpretation and the virological response, emphasize the need for resistance algorithm rules better adapted to HIV-O.
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Smolén J, Kruszyński P, Bratosiewicz-Wąsik J, Witor A, Wąsik TJ. Retrospective analysis of the HIV-1 reverse transcriptase inhibitors' resistance in Silesia, Poland. Med Sci Monit 2011; 17:BR42-7. [PMID: 21278684 PMCID: PMC3524699 DOI: 10.12659/msm.881384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background This study was a retrospective analysis of drug resistance mutations among HIV-1 strains prevalent in Silesia, Poland, from the origin of the epidemic to 2004. The investigations included both type and frequency of the reverse transcriptase inhibitors’ resistance mutations and estimation of the drugs’ resistance levels. Material/Methods Proviral DNA, obtained from peripheral blood mononuclear cells of the 101 HIV-1–infected patients, was amplified and sequenced in the pol gene fragment covering the first 256 codons of the reverse transcriptase (RT). Reverse transcriptase inhibitors resistance mutations were determined and interpreted with the HIVdb: Genotypic Resistance Interpretation Algorithm available from the Stanford University HIV Drug Resistance Database. In the examined population, 35 subjects (34.7%) received no antiretroviral treatment by the time of specimen collection. Results The overall frequency of the RT inhibitors resistance mutations in the studied population was 15.8%. Substitutions related to the reverse transcriptase inhibitors resistance were identified in 10 pol gene sequences (9.9%), all of them were present in the HIV-1 sequences obtained from persons receiving antiretroviral therapy. Conclusions Lack of drug-resistant viruses among treatment-naïve Silesian patients HIV-1-infected before the year 2004 may indicate that there was no transmission of the drug-resistant viruses in the studied population to that time.
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Affiliation(s)
- Joanna Smolén
- Department of Virology, The School of Pharmacy and Division of Laboratory Medicine, Medical University of Silesia, Katowice, Poland.
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Wainberg MA, Brenner BG. Role of HIV Subtype Diversity in the Development of Resistance to Antiviral Drugs. Viruses 2010; 2:2493-508. [PMID: 21994627 PMCID: PMC3185584 DOI: 10.3390/v2112493] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2010] [Revised: 10/26/2010] [Accepted: 10/28/2010] [Indexed: 12/13/2022] Open
Abstract
Despite the fact that over 90% of HIV-1 infected people worldwide harbor non-subtype B variants of HIV-1, knowledge of resistance mutations in non-B HIV-1 and their clinical relevance is limited. Due to historical delays in access to antiretroviral therapy (ART) on a worldwide basis, the vast majority of reports on drug resistance deal with subtype B infections in developed countries. However, both enzymatic and virological data support the concept that naturally occurring polymorphisms among different nonB subtypes can affect HIV-1 susceptibility to antiretroviral drugs (ARVs), the magnitude of resistance conferred by major mutations, and the propensity to acquire some resistance mutations. Tools need to be optimized to assure accurate measurements of drug susceptibility of non-B subtypes. Furthermore, there is a need to recognize that each subtype may have a distinct resistance profile and that differences in resistance pathways may also impact on cross-resistance and the selection of second-line regimens. It will be essential to pay attention to newer drug combinations in well designed long-term longitudinal studies involving patients infected by viruses of different subtypes.
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Affiliation(s)
- Mark A Wainberg
- McGill University AIDS Centre, Jewish General Hospital, 3755 Cote-Ste-Catherine Road, Montreal, Quebec, H3T 1E2, Canada; E-Mail:
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Robertson K, Liner J, Hakim J, Sankalé JL, Grant I, Letendre S, Clifford D, Diop AG, Jaye A, Kanmogne G, Njamnshi A, Langford TD, Weyessa TG, Wood C, Banda M, Hosseinipour M, Sacktor N, Nakasuja N, Bangirana P, Paul R, Joska J, Wong J, Boivin M, Holding P, Kammerer B, Van Rie A, Ive P, Nath A, Lawler K, Adebamowo C, Royal W, Joseph J. NeuroAIDS in Africa. J Neurovirol 2010; 16:189-202. [PMID: 20500018 DOI: 10.3109/13550284.2010.489597] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In July 2009, the Center for Mental Health Research on AIDS at the National Institute of Mental Health organized and supported the meeting "NeuroAIDS in Africa." This meeting was held in Cape Town, South Africa, and was affiliated with the 5th IAS Conference on HIV Pathogenesis, Treatment and Prevention. Presentations began with an overview of the epidemiology of HIV in sub-Saharan Africa, the molecular epidemiology of HIV, HIV-associated neurocognitive disorders (HANDs), and HAND treatment. These introductory talks were followed by presentations on HAND research and clinical care in Botswana, Cameroon, Ethiopia, The Gambia, Kenya, Malawi, Nigeria, Senegal, South Africa, Uganda, and Zambia. Topics discussed included best practices for assessing neurocognitive disorders, patterns of central nervous system (CNS) involvement in the region, subtype-associated risk for HAND, pediatric HIV assessments and neurodevelopment, HIV-associated CNS opportunistic infections and immune reconstitution syndrome, the evolving changes in treatment implementation, and various opportunities and strategies for NeuroAIDS research and capacity building in the region.
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Affiliation(s)
- Kevin Robertson
- Department of Neurology, University of North Carolina, Chapel Hill, North Carolina 27599-7025, USA.
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Divergent evolution in reverse transcriptase (RT) of HIV-1 group O and M lineages: impact on structure, fitness, and sensitivity to nonnucleoside RT inhibitors. J Virol 2010; 84:9817-30. [PMID: 20631150 DOI: 10.1128/jvi.00991-10] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Natural evolution in primate lentiviral reverse transcriptase (RT) appears to have been constrained by the necessity to maintain function within an asymmetric protein composed of two identical primary amino acid sequences (66 kDa), of which one is cleaved (51 kDa). In this study, a detailed phylogenetic analysis now segregates groups O and M into clusters based on a cysteine or tyrosine residue located at position 181 of RT and linked to other signature residues. Divergent evolution of two group O (C181 or Y181) and the main (Y181 only) HIV-1 lineages did not appreciably impact RT activity or function. Group O RT structural models, based on group M subtype B RT crystal structures, revealed that most evolutionarily linked amino acids appear on a surface-exposed region of one subunit while in a noncatalytic RT pocket of the other subunit. This pocket binds nonnucleoside RT inhibitors (NNRTI); therefore, NNRTI sensitivity was used to probe enzyme differences in these group O and M lineages. In contrast to observations showing acquired drug resistance associated with fitness loss, the C181Y mutation in the C181 group O lineage resulted in a loss of intrinsic NNRTI resistance and was accompanied by fitness loss. Other mutations linked to the NNRTI-resistant C181 lineage also resulted in altered NNRTI sensitivity and a net fitness cost. Based on RT asymmetry and conservation of the intricate reverse transcription process, millions of years of divergent primate lentivirus evolution may be constrained to discrete mutations that appear primarily in the nonfunctional, solvent-accessible NNRTI binding pocket.
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Depatureaux A, Leoz M, De Oliveira F, Gueudin M, Damond F, Descamps D, Brun-Vézinet F, Lemée V, Simon F, Barin F, Plantier JC. [Specific diagnosis and follow-up of HIV-1 group O infection: RES-O data]. Med Mal Infect 2010; 40:669-76. [PMID: 20646884 DOI: 10.1016/j.medmal.2010.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2009] [Revised: 01/04/2010] [Accepted: 04/21/2010] [Indexed: 10/19/2022]
Abstract
INTRODUCTION HIV-1 group O (HIV-O), mainly found in Cameroon, has a very high genetic diversity with consequences on the diagnosis and treatment of patients, requiring the development of specific tools. OBJECTIVE We present the currently available tools for the specific detection of HIV-O and its therapeutic monitoring, and the first RES-O data, a French network for the identification and monitoring of patients infected by HIV-O. METHOD The diagnosis of infection was confirmed by group-specific envelope serotyping. The viral load was assessed by a specific technique, LTR-O, developed in the laboratory and compared to the nonspecific kit RealTime HIV-1 (Abbott). The sequencing of antiretroviral target regions (Protease, Reverse Transcriptase (RT), Integrase and Gp41), was performed by specific primers. The analysis of resistance mutations was performed with the ANRS algorithm used for HIV-M. RESULTS HIV-O infection was confirmed for 117 patients. Measuring viral load showed the two techniques were equivalent, but with a tendency to under-quantification for the Abbott technique greater than 1 log for 5% of samples. 70 to 100% of the studied strains had at least 10 mutations in the Protease, four 4 in the RT, and one in Gp41, resulting in a natural genotypic resistance to some anti-retroviral molecules. DISCUSSION The diagnosis and monitoring of HIV-O infection is now possible. However, the impact of this variant's natural polymorphism on response to treatment remains undocumented.
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Affiliation(s)
- A Depatureaux
- Laboratoire associé au CNR du VIH, EA 2656, CHU Charles-Nicolle, 76031 Rouen, France
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Baseline genotypic and phenotypic susceptibilities of HIV-1 group O to enfuvirtide. Antimicrob Agents Chemother 2010; 54:4016-9. [PMID: 20547806 DOI: 10.1128/aac.00100-10] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
We assessed the natural genotypic and phenotypic susceptibilities to enfuvirtide of 171 HIV group O (HIV-O) samples and 29 strains, respectively. The N42D resistance-associated mutation in the gp41 region was detected in 98% of cases. The phenotypic assay showed a wide range of baseline susceptibilities, with 50% inhibitory concentrations (IC(50)s) from 4 to 5,000 nM, a range similar to that reported for HIV-1 group M. Thus, despite the natural genotypic resistance conferred by the N42D signature mutation, HIV-O variants appear to be phenotypically susceptible. Enfuvirtide could therefore potentially be used in antiretroviral treatments for HIV-O-infected patients.
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HIV Genetic Diversity and Drug Resistance. Viruses 2010; 2:503-531. [PMID: 21994646 PMCID: PMC3185604 DOI: 10.3390/v2020503] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2009] [Revised: 12/11/2009] [Accepted: 02/01/2010] [Indexed: 02/07/2023] Open
Abstract
Most of the current knowledge on antiretroviral (ARV) drug development and resistance is based on the study of subtype B of HIV-1, which only accounts for 10% of the worldwide HIV infections. Cumulative evidence has emerged that different HIV types, groups and subtypes harbor distinct biological properties, including the response and susceptibility to ARV. Recent laboratory and clinical data highlighting such disparities are summarized in this review. Variations in drug susceptibility, in the emergence and selection of specific drug resistance mutations, in viral replicative capacity and in the dynamics of resistance acquisition under ARV selective pressure are discussed. Clinical responses to ARV therapy and associated confounding factors are also analyzed in the context of infections by distinct HIV genetic variants.
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Abstract
OBJECTIVE To define a routine algorithm for the specific diagnosis and complete follow-up of HIV-1 group O (HIV-O) infections in Cameroun. METHODS During 18 months, samples referred to Centre Pasteur du Cameroun for HIV testing or viral monitoring were screened for HIV-O infection with an in-house serotyping assay. HIV-O viral load was quantified by real-time polymerase chain reaction in the LTR gene and resistance genotyping was performed on pol and env sequences. RESULTS Of the 7030 samples tested, 78 HIV-O infections (1.1%) were identified, including 7 M and O dually seroreactive samples (9%). All treatment-naive patients and 59% of the patients receiving HAART had detectable viral loads. Analysis of pol sequences from 15 treatment-naive patients revealed a high number of polymorphisms in the protease region, with natural residues implicated in genotypic resistance to tipranavir and saquinavir for HIV-1 group M according to the Agence Nationale de Recherches sur le Sida et les Hépatites virales algorithm. Six patients (40%) harbored the 181C mutation conferring natural resistance to nonnucleoside reverse transcriptase inhibitors. Among antiretroviral-treated patients, major resistance mutations described for HIV-1 group M were found. CONCLUSIONS HIV-O prevalence remains relatively low in Cameroun. The cocirculation of groups M and O in this country leads to replicative dual infections. HIV-O-infected patients in this region can now benefit from effective and specific tools for a complete monitoring of infection. However, further studies are needed to understand long-term response to antiretrovirals of these complex variants.
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Resistance and viral subtypes: how important are the differences and why do they occur? Curr Opin HIV AIDS 2009; 2:94-102. [PMID: 19372873 DOI: 10.1097/coh.0b013e32801682e2] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE OF REVIEW The global HIV-1 pandemic has evolved to include 11 subtypes and 34 circulating recombinant forms. Our knowledge of HIV-1 response to antiretroviral drugs and emergent drug resistance has, however, been limited to subtype B infections circulating in Europe and North America, with little comparative information on non-B subtypes representing approximately 90% of worldwide epidemics. This review summarizes publications in the past year that highlight intersubtype differences influencing viral susceptibility to antiretroviral drugs and emergent drug resistance. RECENT FINDINGS Cumulative findings from clinical studies suggest that antiretroviral therapy will be of benefit in the overall treatment of non-B subtype infections, and result in drug-resistance profiles comparable to those observed for subtype B infections. Nevertheless, the 10-15% sequence diversity in the Pol region contributes to intersubtype differences in response to particular nucleoside and non-nucleoside analogues, as well as protease inhibitors. Distinct signature mutations and mutational pathways are identified for specific non-B subtypes. The implications of subtype on clinical outcome and interpretative algorithms are described. SUMMARY Understanding intersubtype differences in drug resistance is important in optimizing treatment strategies in resource-poor settings. Hopefully, this may assist in the design of prophylactic approaches to prevent HIV-1 horizontal and vertical HIV-1 transmission.
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Plantier JC, Djemai M, Lemée V, Reggiani A, Leoz M, Burc L, Vessière A, Rousset D, Poveda JD, Henquell C, Gautheret-Dejean A, Barin F. Census and analysis of persistent false-negative results in serological diagnosis of human immunodeficiency virus type 1 group O infections. J Clin Microbiol 2009; 47:2906-11. [PMID: 19625478 PMCID: PMC2738113 DOI: 10.1128/jcm.00602-09] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2009] [Revised: 05/06/2009] [Accepted: 07/15/2009] [Indexed: 11/20/2022] Open
Abstract
Human immunodeficiency viruses (HIV) have a high level of genetic diversity. The outlier variants of HIV type 1 (HIV-1) group O are distantly related to HIV-1 group M. Their divergence has an impact on serological diagnosis, with a risk of false-negative results. In this study, we report 20 failure cases, involving patients with primary or chronic infection, in France and Cameroon between 2001 and 2008. Our results indicate that some assays detected group O infection much less efficiently than others. Two major reasons for these false-negative results were identified: the presence or absence of a group O-specific antigen (and the designed sequence) for the detection of antibodies and the greater envelope variability of group O than of group M strains. This study highlights the complexity of screening for these divergent variants and the need to evaluate test performance with a large panel of strains, due to the extensive diversity of group O variants.
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Affiliation(s)
- J-C Plantier
- Laboratoire de Virologie & Laboratoire associé au Centre National de Référence du VIH, Institut de Biologie Clinique, hôpital Charles Nicolle, CHU de Rouen, 1 rue de Germont, 76031 Rouen, France.
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Virological response to highly active antiretroviral therapy in patients infected with human immunodeficiency virus type 2 (HIV-2) and in patients dually infected with HIV-1 and HIV-2 in the Gambia and emergence of drug-resistant variants. J Clin Microbiol 2009; 47:2200-8. [PMID: 19420165 DOI: 10.1128/jcm.01654-08] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Drug design, antiretroviral therapy (ART), and drug resistance studies have focused almost exclusively on human immunodeficiency virus type 1 (HIV-1), resulting in limited information for patients infected with HIV-2 and for those dually infected with HIV-1 and HIV-2. In this study, 20 patients, 12 infected with HIV-2 and 8 dually infected with HIV-1 and HIV-2, all treated with zidovudine (ZDV), lamivudine (3TC), and lopinavir-ritonavir (LPV/r), were followed up longitudinally for about 3 years. For 19/20 patients, viral loads were reduced to undetectable levels; the patient whose viral load remained detectable reported adverse effects associated with LPV/r that had caused him to stop taking all the drugs. HIV-2 strains containing mutations in both the protease and the reverse transcriptase gene that may confer drug resistance were observed in two patients with viral rebound, as early as 130 days (4.3 months) after the initiation of therapy. We conclude that the combination of ZDV, 3TC, and LPV/r is able to provide efficient and durable suppression of HIV-1 and HIV-2 for as long as 3 years in HIV-2-infected and dually infected patients. However, the emergence of HIV-1 and HIV-2 strains containing drug-resistant mutations can compromise the efficacy of this highly active ART.
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Piñeiro Pérez R, Mellado Peña MJ, Holguín A, Cilleruelo MJ, García Hortelano M, Villota J, Martín Fontelos P. [HIV-1 genetic variability in non Spaniard infected children]. An Pediatr (Barc) 2009; 70:20-6. [PMID: 19174115 DOI: 10.1016/j.anpedi.2008.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2008] [Revised: 07/22/2008] [Accepted: 08/01/2008] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION The prevalence of HIV-1 non-B subtypes (HIV-NBS) is increasing in Europe, because of emigration from countries where genetic variants are endemic. Although HIV-NBS could have a different clinical evolution and could respond differently to antiretrovirals (AR) than B-subtypes, these variant's response remain undocumented. AIMS To identify HIV-1 genetic variants and to determine clinical evolution in a non-Spaniard children infected with HIV-1. PATIENTS AND METHOD Children with HIV-1 infection from endemic countries were tested for HIV-1 subtypes between 1-1-1988 and 31-12-2006. Twelve children less than 18 years old and born abroad were selected. RESULTS HIV-NBS were isolated in 5 children (42%): CRF2_AG recombinant in 3 cases (Equatorial Guinea), Subtype C in one (Equatorial Guinea) and CRF13_cpx in last one (India). DISCUSSION Because of the increasing frequency of patients with HIV-NBS and their unknown long-term evolution, all children from endemic countries should be tested for HIV subtypes. We believe new studies with more patients during longer times could reveal differences in these patient's clinical, immunological and virological evolution.
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Soares MA. Drug resistance differences among HIV types and subtypes: a growing problem. ACTA ACUST UNITED AC 2008. [DOI: 10.2217/17469600.2.6.579] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Although HIV-1 subtype B accounts for only 10% of worldwide HIV infections, almost all knowledge regarding antiretroviral (ARV) drug development and viral resistance is based on this subtype. More recently, an increasing body of evidence suggests that distinct HIV genetic variants possess different biological properties, including susceptibility and response to ARVs. In this review, we will summarize recent in vitro and in vivo studies reporting such differences. In general terms, infections with most HIV variants respond well to ARVs, but minor differences in susceptibility, in the emergence and selection of subtype-specific drug resistance mutations and in the acquisition of similar mutations over the period of ARV exposure have been reported. Such differences impact on drugresistance interpretation algorithms, which are mostly based on inference from sequence information. Despite the differences observed, clinical response to ARV therapy among subjects infected with distinct HIV variants is effective, and the dissemination of ARV access in developing countries where non-B subtypes prevail should not be delayed.
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Affiliation(s)
- Marcelo A Soares
- Departamento de Genética, Universidade Federal do Rio de Janeiro, Divisão de Genética, Instituto Nacional de Câncer CCS, Bloco A, sala A2–120, Cidade Universitária, Ilha do Fundão, 21949-570, Rio de Janeiro, Brazil
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