Primary Infection with Zidovudine-Resistant Human Immunodeficiency Virus Type 1

Erice, Alejo; Mayers, Douglas L.; Strike, David G.; Sannerud, Kim; McCutchan, Francine E.; Henry, Keith; Balfour, Henry H.

doi:10.1056/nejm199304223281605

Cited by 224 publications

(92 citation statements)

References 15 publications

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“…This main objective of this study was to assess if the decision to change a regimen based on genotyping test had a positive effect on response, proven by reductions in viral load and improvement in CD 4 + T-lymphocyte counts. The inclusion criteria were: 1-individuals older than 18 years; 2-HIV-1 positive and under regular antiretroviral treatment; 3-registered in the CTR/DIP pharmacy; 4-viral load = 5,000 copies/mL, collected up to three months before genotyping, or before the ARV regimen switch in the group of patients who had not been submitted to the test; 6-Virological failure characterized according to the criteria set by the PNSTD/AIDS Consensus Group on Antiretroviral.…”

Section: Methodsmentioning

confidence: 99%

“…When data were retrospectively collected, the patients had to have been followed up for a minimum period of 12 months after switching. In group 2, at least two CD 4 + Tlymphocyte counts and viral loads were assessed during the period. HIV-1 genotyping was done for 16 patients of this group.…”

Section: Methodsmentioning

confidence: 99%

“…HIV-1 genotyping was done for 16 patients of this group. The CTR/DIP service has a serum library, where plasma from patients from which viral load and CD 4 + T-lymphocyte count data had been collected is stored at -70 o C. The plasma analyzed was that submitted to viral load analysis near the time of switching (up to three months before the switch).…”

Section: Methodsmentioning

confidence: 99%

“…Consequently, the effectiveness of this program is threatened by the emergence of resistant viral strains selected during treatment, which may be transmitted to other individuals. In 1993, Erice et al reported zidovudine-resistant viral strain (T215Y) transmission, in which the patient presented a prolonged acute retroviral syndrome with a high viral load (VL) [4].…”

mentioning

confidence: 99%

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Treatment switch guided by HIV-1 genotyping in Brazil

Tupinambás¹,

Ribeiro²,

Aleixo³

et al. 2006

Braz J Infect Dis

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We assessed the performance of HIV-1 genotyping tests in rescue therapy. Patients were divided into two groups: group 1 (genotyped), included those switching to new antiretroviral drugs based on HIV-1 genotyping data, and group 2 (standard of care -SOC), comprised those in rescue therapy who had not used this test. This was an open and non-randomized study, with 74 patients, followed up for a mean period of 12 months, from February 2002 to May 2003. The groups differed in the duration of antiretroviral use, experience with diverse drug classes (non-nucleoside reverse transcriptase inhibitors and protease inhibitors) and viral load <2.6 log 10 copies/mL at any time during treatment. In 23 patients (group 1), the switch in antiretroviral (ARV) regimen was based on genotyping data; this test was not used for 51 patients (group 2). Two CD 4 + lymphocyte counts and viral load counts were made for each patient during the study. Data from the pharmacy where patients received antiretroviral agents, medical charts, and direct interviews with patients to assess compliance to treatment, were analyzed. In the genotyped group, the average drop in viral load was 2.8 log 10 , compared with a 1.5 log 10 difference in group 2; the difference was significant in the first assessment performed six months after switching (p=0.001). Considering the patients with viral load < 2.6 log 10 (400 copies/mL) after switching, the patients in group 1 had a better performance in the first assessment (73.9% versus 31.1% in groups 1 and 2, respectively); this difference was significant (p=0.001). In multivariate analysis, the variables associated with a greater drop in viral load in the first assessment were the patients whose switching was based on genotyping (group 1), those with a past history of viral load < 2.6 log 10 and correct use of antiretroviral agents. In conclusion, the genotyping test and adherence were found to be independent factors for success in the management of patients who failed treatment.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Treatment switch guided by HIV-1 genotyping in Brazil

Tupinambás¹,

Ribeiro²,

Aleixo³

et al. 2006

Braz J Infect Dis

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“…The widespread use of antiretroviral drugs has led to the development and subsequent transmission of drug-resistant HIV-1 and the transmission of drug-resistant viruses has been documented through vertical, sexual, and parenteral routes [36][37][38]. Patients who are infected with drug-resistant HIV-1 and initiate antiretroviral therapy show poorer treatment responses than patients who are infected with wild-type (WT) viruses [34,35].…”

Section: Anti-hiv Therapy Drug Resistance and Its Dissemination In Cmentioning

confidence: 99%

Snapshot of HIV pathogenesis in China

et al. 2005

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Several reviews have focused on the nature of HIV infection and its spread in various geographical regions of China. In contrast, this review provides a comprehensive update on the prevalence of multiple HIV-1 subtypes, consequent emergence of recombinant and novel forms of HIV-1 in China, and the implications this may have on HIV diversity and the development of effective vaccines. In addition it also examines the dissemination of primary drug resistance in therapy naïve patients, as well as co-infections with two other important viruses-hepatitis B and C. The main purpose of this review is to provide a current snapshot of HIV-1 pathogenesis in China and possibly shed some light on the future of HIV evolution, and potential challenges for future vaccine and anti-retroviral therapeutics against HIV strains in this area.

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Is Zidovudine a Prophylactic Treatment for Health Care Workers?-Reply

Forseter¹

1995

Arch Intern Med

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Forseter et al1 describe a population of 113 health care workers exposed to human immunodeficiency virus (HIV) after needlestick injury. Sixty of them (53%) took zidovudine. Only 21 (35%) of the 60 health care workers completed the full 42-day course of therapy, and most of them (73%) suffered many side effects. No seroconversion was detected in this cohort of untreated and treated subjects. We want to mention that seroconversion can occur during zidovudine treatment given after HIV exposure; several cases of clinical failure have been reported. We previously described a nurse in whom seroconversion developed after a deep needlestick injury with a needle that had been contaminated by a patient with acquired immunodeficiency syndrome.2 Preventive procedures were started immediately: the wound was bled and washed with bleach for 15 minutes, and oral zidovudine therapy (250 mg four times per day [1 g/d]) was initiated 90 minutes after the incident occurred. At the time of the incident, the nurse was HIV negative. She presented with fever, sweating, headache, and cervical lymphadenopathy 3 weeks after exposure. One week later, serologie tests were positive for HIV type 1 p24 antigen (170 pg/mL), and 7 weeks after exposure, further serologie tests (enzymelinked immunosorbent assay and Western blot) demon¬ strated seroconversion. No other risk factor was identi¬ fied. Zidovudine treatment was started within the time limits found to be crucial for a protective effect in animal studies.1 A decreased sensitivity of the HIV-1 strain to zi¬ dovudine is a possibility. However, zidovudine may not completely inhibit reverse transcription or block cell-tocell transmission of HIV-1.3 Some experiments with vari¬ ous animal models4 and cases of seroconversion that have occurred during zidovudine treatment3 seem to invali¬ date zidovudine's efficacy. These observations associated with the well-known side effects and potential long-term complications emphasize the need for strict adherence to recommended infection-control procedures. Zidovudine use may be justified, but studies are needed to estimate the real indications for, and the optimal dosage and du¬ ration of, prophylactic therapy. dovudine delays but does not prevent the transmission of MAIDS by LP-BM5 MuLv-infected macrophage-monocytes. J Acquir Immune Defic Syndr. 1992; 5:571-576. 4. Schinazi RF, Anderson DC, Fultz P, et al. Prophylaxis with antiretroviral agents in rhesus macaques inoculated with simian immunodeficiency virus. In: Program and abstracts of the 30th Interscience Conference on Antimicrobial Agents and Chemotherapy; October 21-24, 1990; Atlanta, Ga. Abstract 962. 5. Looke DFM, Grove DI. Failed prophylactic zidovudine after needlestick injury. Lancet. 1990;335:1280. In replyWe appreciate the comments of Coutellier and colleagues, who point out that despite zidovudine therapy, human immunodeficiency virus (HIV) may still be transmitted to an exposed health care worker. This has happened on at least eight occasions,1-3 including the case cited by Coutellier et a...

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Primary Infection with Zidovudine-Resistant Human Immunodeficiency Virus Type 1

Cited by 224 publications

References 15 publications

Treatment switch guided by HIV-1 genotyping in Brazil

Treatment switch guided by HIV-1 genotyping in Brazil

Snapshot of HIV pathogenesis in China

Is Zidovudine a Prophylactic Treatment for Health Care Workers?-Reply

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