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Genotypic Resistance Profiles in patients failing Darunavir Containing Regimens: The Role Of Interpretation Algorithms

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ABSTRACT

The study aimed at defining protease (PR) resistance mutations associated with darunavir (DRV) failure and PR resistance evolution at DRV failure, in a large database of HIV patients. Overall, 1104 patients were included: only 118 (10.7%) failed at a median observation time of 16 months. The mean number of PR mutations at baseline was 2.7, but it was higher in patients who subsequently failed DRV (3.8 vs. 2.6). In addition the number of PR mutations increased at failure (mean 4.3). The higher statistical difference at baseline between failing vs. non-failing patients was observed for V32I and I84V mutations. At DRV failure the major increase was still observed for V32I; I54L, V11I and I50V also increased. Despite the increment in the mean number of mutations per patient between baseline and failure, in 21 patients (17.8%) at baseline and 36 (30.5%) at failure no PR mutation was detected. Different interpretation systems yielded different levels of DRV full resistance both at baseline and at failure. The HIV-DB system showed a low level of DRV full resistance, with a low increase at failure. In contrast, the Rega interpretation algorithm detected the highest proportion of full DRV resistant isolates and both Rega and ARNS algorithms detected significant differences in full DRV resistance between patients who subsequently failed versus those who responded to the DRV containing regimen. Rega and ARNS algorithms also showed a further increase in full resistance to DRV at failure, with ARNS that almost doubled the proportion of full resistant patients.
Keywords: Darunavir; Genotypic resistance; Protease inhibitors; Interpretation algorithms.

Articolo presente in – HAART and correlated pathologies n. 11 –

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Aesthetic correction for facial lipoatrophy in AIDS subjects: experience with a hydrogel filler

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ABSTRACT
The aim of this study was to estimate the bioactivity, efficacy and safety of facial injections of a polyacrylamide hydrogel (PAIG), Aquamid® in HIV-infected patients with mild, moderate and severe degrees of facial lipoatrophy that may may cause severe psychological disturbances and lack of self-interest. A total of 29 patients were enrolled and assigned for injection of Aquamid®. At each treatment one to two vials of PAIG were injected on the first day and every four weeks for some months on the basis of different stages of facial lipoatrophy severity. The subjects were evaluated by clinical examination, and standardized photographs were taken before treatment, scheduled for 12, 24 and 48 weeks. Patients were also advised to avoid sunburn or frostbite in the area where polyacrilamide was injected. All of our patients were very satisfied with the aesthetic result and the consistency and elasticity of the treated area at the twelve month follow-up. All patients referred pain (scale 0-10) at the time of injection. Excellent results were confirmed in the parietal area and lower third of the face, upper jaw and lower jaw. The advantage of this hydrogel relates to its non-biodegradability and its good tolerability. Our product does not cause any allergic reaction or any other immunological effect either in animals or in humans, and above all it does not migrate.
Keywords: Lipoatrophy; HIV-infected patients; Polyacrylamide hydrogel; Facial augmentation; Adverse reactions.

Articolo presente in – HAART and correlated pathologies n. 4 –

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