ResistÃncia secundÃria aos anti-retrovirais em indivÃduos com AIDS e prevalÃncia de subtipos do HIV-1 no Nordeste do Brasil: 2002 a 2004

AUTOR(ES)
DATA DE PUBLICAÇÃO

2005

RESUMO

The treatment of HIV infection has contributed for the changing in the mobility and mortality profile of AIDS in Brazil, mainly since 1996, when the Highly Active Antiretroviral Therapy (HAART) begun to be used. In spite of the advance on HIV treatment, with reduction on opportunistic infections and hospitalizations, and an important increase on life expectancy. Some problems with this therapy have been related. Some patients could not have their viral replication suppressed because of many factors, like drugs resistance. This study had the objective of analyzing: the HIV mutation profile related to the antiretroviral resistance after therapeutic fail; the distribution of HIV subtypes, present on Northeastern Brazil; and the mutations on the subtypes more prevalent. It has analyzed 576 blood samples from patients with AIDS and therapeutic failure, collected on six different states of the Brazilian Northeast, since the year 2002 until 2004. The genotyping Kit ViroSeqâ (Celera Diagnostic, Abbott Laboratories, USA), that automatically processes the DNA generated, has been used to make viral amplification, identifying the mutations related with the HIVâs pol gene resistance to the antiretroviral drugs. The sequence has been analyzed by the Stanford Sequence Data Base for viral subtypes identification. The laboratory exams were done at Central Laboratory of Public Health of Pernambuco, that is part of the National Genotyping Network from the National Programm of STD/AIDS. The results reveled that 91,1% of the patients had mutation for the reverse transcriptase nucleoside inhibitors (NRTI), 58,7% for the reverse transcriptase non-nucleoside inhibitors (NNRTI) and 94,8%, for the protease inhibitors (PI). The mutations more prevalent were 184V and 215E for NRTI, 103N and 190A for NNRTI and secondary mutation 63P and 36I for PI. The resistance related to the drugs classes had evidenced that 14% had resistance for only one class, 61% for two classes and 18,9% for three classes of antiretroviral. The subtype B was the most prevalent (82,4%) followed by subtype F (11,8%) and recombinant forms (4,6%). Around 72% of the samples from subtype F had been from people leaving in Pernambuco. The prevalence of mutations related to NRTI and NNRTI was the same in the two subtypes, but the codons analysis, related with PI, showed greater frequency of mutations on the code 63 on subtype B, and code 36 on subtype F. The findings concerning the present study showed an elevated frequency of primary mutations, that provides resistance for NRTI and NNRTI, apparently with few differences occurring from therapeutic failure. The monitoring of patients with treatment failure given by genotyping exams is an important tool to aid physicians on the rescue therapy also reducing expenses with inefficient or inadequate therapies.Therefore, the test provides a way to verify the regional subtypes prevalence. The antiretroviral resistant virus circulation may represent a problem to public health because it increases the risk of transmission of resistant strains

ASSUNTO(S)

genotyping vÃrus da imunodeficiÃncia adquirida tipo 1 medicina genotipagem resistÃncia anti-retroviral northeast antiretroviral resistance subtypes nordeste human immunodeficiency virus sub-tipos

ACESSO AO ARTIGO

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