Drug resistance has been reported for all of the major antiretroviral agents in clinical use. Drug resistant strains of HIV have been transmitted from person to person and have been isolated in patients who have not yet been administered antiretroviral agents. If the strain initially infecting a person is resistant to one or more of the agents in his/her therapeutic regimen, resistance may occur rapidly to the other agents. In such a case viral load may greatly increase, allowing rapid development of further resistance through mutation and recombination.
Viral drug resistance is becoming an increasingly important issue as recommendations suggest starting HIV-infected persons, particularly those with high viral load, on therapy earlier in the course of disease. In the future, clinicians' awareness of the drug resistance "profile" of viruses in their community may help in their selection of antiretroviral agents for therapy and post-HIV- exposure prophylaxis.
To better characterize the spectrum of antiretroviral drug resistance and viral strains among HIV-infected persons in Los Angeles.
The CDC is sponsoring this project as a pilot study for surveillance of antiretroviral resistance and HIV strains. Los Angeles is one of four cities participating. Subjects are obtained through the Project Open Window Study and the County/USC Comprehensive Maternal-Child Management and Research Center. Subjects enrolled are recent seroconverters who are antiretroviral-drug naive and antiretroviral-drug naive pregnant women, regardless of when they seroconverted. A brief questionnaire is administered, and 20 ml of blood are drawn and sent to the CDC. Subjects who are enrolled in the Adult/Adolescent Spectrum of Disease (ASD) Project are followed through their ASD records. Subjects not in ASD are followed through abstraction of their medical records. Follow-up specimens may be requested later to monitor changes in resistance. All laboratory processing of the blood is done by the CDC. Their laboratory uses both genotypic and phenotypic methods to evaluate drug resistance. Specimens are screened for HIV-1 subtype using a series of subtype-specific peptide EIA tests.
Study Completion Date:
End of 1999.
Jane Turner, M.S.