Therapeutics & Drugs Brief

HIV-1 Drug Resistance in Newly Infected Individuals

Source: Boden D, et al. JAMA 1999;282:1135-1141.

As many as half of hiv-1 infected individuals treated with antiviral therapy may develop resistance. Contributing factors include serial monotherapy, uninhibited viral replication due to inadequate suppression by less than maximally effective agents, difficulty adhering to complicated regimens often associated with substantial burden of side effects, and therapy begun late in the course of the disease. Transmission of multidrug-resistant HIV-1 virus is a serious concern. To evaluate the demographics of this problem, Boden and associates evaluated mutations in 80 newly HIV-1 infected individuals who acquired the disease between July 1995 and April 1998; during this time, multidrug treatment of HIV had become the standard methodology.

More than 16% of samples analyzed demonstrated resistance to one or more antiretroviral agents and almost twice that number showed a three-fold or greater reduction in susceptibility to at least one retroviral agent. Only about 4% of samples demonstrated multidrug resistance.

Study subjects in this group came primarily from a population of urban homosexual men. Hence, demographics here described may not reflect other community settings and may not be applicable to women or heterosexual men.

Boden et al suggest that clinical trials that evaluate potential virological and immunological benefits achieved by using resistance assay-guided therapeutic regimens are in order.

The Therapeutics and Drugs Brief in this issue was written by Louis Kuritzky, MD, Courtesy Clinical Assistant Professor, University of Florida, Gainesville, FL.