Université Pierre et Marie Curie, Paris 6, France.
J Antimicrob Chemother. 2013 Jan;68(1):188-9. doi: 10.1093/jac/dks362. Epub 2012 Sep 6.
The genotypic method is reliable enough for the determination of tropism and largely preferred in Europe. However, careful interpretation is essential when assessing HIV genotypic resistance during treatment interruption (TI) due to the possible disappearance of resistant strains. The results of HIV genotypic tropism testing in such a context remain unknown.
First, we studied changes in tropism in patients included in a structured TI assay: the Reverse study. Second, we investigated the unexpected tropism switches from X4 to R5 recorded in our routine database.
Tropism determination was possible in 21 patients of the Reverse study, 9 of whom had an X4 virus (43%) at baseline. Two patients displayed a change of tropism during TI, both switching from X4 to R5. Regarding the database investigation, 7 of the 222 patients with at least two plasma tropism determinations recorded in the database displayed a switch from X4 to R5. TI due to non-compliance at the time of the tropism change was reported for five of these seven patients.
We have shown that the redistribution of the HIV population caused by TI could potentially result in X4 viruses becoming undetected and inappropriate prescription of a CCR5 receptor antagonist. Therefore, genotypic tropism results should be interpreted with caution in such a context.
基因型方法对于确定嗜性已经足够可靠，在欧洲被广泛采用。然而，由于可能会出现耐药株的消失，在治疗中断（TI）期间评估 HIV 基因型耐药性时，需要谨慎解释。在这种情况下，HIV 基因型嗜性检测的结果仍然未知。
首先，我们研究了在一项结构化 TI 检测（Reverse 研究）中纳入的患者的嗜性变化。其次，我们调查了在常规数据库中记录到的 X4 向 R5 的意外嗜性转换。
Reverse 研究中的 21 名患者的嗜性确定是可能的，其中 9 名患者在基线时有 X4 病毒（43%）。2 名患者在 TI 期间显示嗜性发生变化，均从 X4 转变为 R5。关于数据库调查，在数据库中至少有两次血浆嗜性测定记录的 222 名患者中，有 7 名显示从 X4 向 R5 转变。在这些患者中的 5 名患者中，报告了由于在嗜性改变时不遵守治疗而导致的 TI。
我们已经表明，TI 引起的 HIV 群体重新分布可能导致 X4 病毒无法检测到，并导致不合适地开处方使用 CCR5 受体拮抗剂。因此，在这种情况下，应谨慎解释基因型嗜性结果。
