エイズと臨床研究のジャーナル

Introduction: Drug resistance mutations (DRM) in viral RNA are important in defining treatment most likely to provide effective antiretroviral therapy (ART) in HIV-1 infected patients. Detection of DRM in peripheral blood mononuclear cell (PBMC) DNA is another source of information, although the clinical significance of DRMs in proviral DNA is less clear.

Materials and Methods: From 25 patients receiving ART at a center in Zimbabwe, 32 blood samples were collected. Dideoxy-sequencing of gag-pol identified subtype and resistance mutations from plasma viral RNA and proviral DNA. Drug resistance was estimated using the calibrated population resistance tool on www.hivdb.stanford. edu database. Numerical resistance scores were calculated for all antiretroviral drugs and for the subjects’ reported regimen. Phylogenetic analysis as maximum likelihood was performed to determine the evolutionary distance between sequences.

Results: Of the 25 patients, 4 patients (2 of which had given 2 blood samples) were not known to be on ART (NA) and had exclusively wild-type virus, 17 had received Protease inhibitors (PI), 18, non-nucleoside reverse transcriptase inhibitors (NNRTI) and 19, two or more nucleoside reverse transcriptase inhibitors (NRTI). Of the 17 with history of PI, 10 had PI mutations, 5 had minor differences between mutations in RNA and DNA. Eighteen samples had NNRTI mutations, six of which demonstrated some discordance between DNA and RNA mutations. Although NRTI resistance mutations were frequently different between analyses, mutations resulted in very similar estimated phenotypes as measured by resistance scores. The numerical resistance scores from RNA and DNA for PIs differed between 2/10, for NNRTIs between 8/18, and for NRTIs between 17/32 pairs. When calculated resistance scores were collapsed, 3 pairs showed discordance between RNA and DNA for at least one PI, 6 were discordant for at least one NNRTI and 11 for at least one NRTI. Regarding phylogenetic evolutionary analysis, all RNA and DNA sequence pairs clustered closely in a maximum likelihood tree.

Conclusion: PBMC DNA could be useful for testing drug resistance in conjunction with plasma RNA where the results of each yielded complementary information about drug resistance. Identification of DRM, archived in proviral DNA, could be used to provide for sustainable public health surveillance among subtype C infected patients.

Background: Health-related quality of life (HRQOL) is an important issue for HIV-infected patients on antiretroviral therapy (ART). The purpose of our study was to highlight particular items of HRQOL correlated to some monitoring parameters during ART in resource-limited settings (RLS): mean CD4 count, adherence, drug side effects (DSE), cotrimoxazole prophylaxis, self-medication and opportunistic infections.

Methods: HRQOL and self-medication were evaluated cross sectionally at eighteenth month of ART with 231 Ivorian HIV-infected patients. Our survey was performed using the MOS-HIV questionnaire for HRQOL. The mean CD4 count during ART was determined with values measured at sixth month (M6), twelfth month (M12), eighteenth month (M18). Routine data from clinical visit at M6, M12, and M18 were used to assess longitudinally the quality of adherence, the occurrence of drug side effects and opportunistic infections during ART. These parameters were evaluated by each patient’s physician.

Results: Regardless of CD4 counts, scores of HRQOL items attached to them were homogeneous, (patients had an equivalent quality of life). Good adherence was significantly correlated with high general health perception scores, and overall quality of life component scores. Physical functioning and cognitive functioning were significantly influenced by the occurrence of DSE; scores of these items were higher without DSE. Considering the global HRQOL scores, the existence or not of cotrimoxazole prophylaxis did not influence differently the HRQOL scores. Patients who practiced self-medication had global HRQOL scores not significantly different from those who did not practice it. However, we found significant correlations between the practice of self-medication and mental health, energy/ fatigue and cognitive functioning. The scores of these items were greater in patients not practicing self-medication.

Conclusion: Information about therapeutic risks related to incomplete adherence, DSE and self-medication must be a crucial element integrated in counseling for HIV-infected patients to help optimize their HRQOL in RLS.