Efetividade geral do teste de genotipagem do HIV-1 em Minas Gerais, Brasil nos anos de 2010, 2014 e 2016

Abstract

Introduction: Several studies have documented the efficacy and effectiveness of salvage therapy guided by genotyping tests and have shown the possibility of sustaining plasma levels of HIV viral load (VL) low or undetectable level of the methods used. However, the general effectiveness of rescue therapy guided by the genotyping test over a long period of time and through the direct observation of results obtained in clinical practice has not yet been evaluated in Brazil and Minas Gerais. Main objective: To evaluate the virological and immunological efficacy of the antiretroviral regimen based on the genotyping test of HIV-1 infected patients in follow-up at specialized services in Minas Gerais in the years 2010, 2014 and 2016. Methodology: Retrospective cohort study of patients Minas Gerais, Brazil, aged 18 years and older, who underwent HIV-1 genotyping in the years 2010, 2014 and 2016. The primary outcomes evaluated at week 48 (± 4 weeks) follow-up will be the proportion of patients with viral load ) <50 copies / ml or <200 copies / ml and the variation in the CD4+ - T lymphocyte counts in relation to the examinations prior to genotyping. The data were obtained through national databases (SICLOM and SISCEL) and analyzed in the statistical analysis software SPSS (version 15.0). The viral sequences obtained in the genotyping test were analyzed using the Stanford HIV-DB resistance mutation and sensitivity mutation algorithm. Results: 485 patients who underwent the genotyping test in the three years were analyzed. The results show that the majority of the participants were male (277/57%) and with average age of 42 years. This study showed an virological effectiveness of 71.1% of ART switch based on the genotyping test in the three years evaluated. Regarding the resistance mutations related to NRTIs, there is a decrease in the prevalence of mutations of the thymidine analogues (TAM-1 and TAM-2) ranging from 1.4% to 0.0% and from 11.6% to 3,8% respectively. There were no mutations related to the insertion complex 69 and 151. There was an increase in the mutation in the K65R codon over time, probably associated with the use of Tenofovir (TDF), from 3.6% to 10.9% in the last studied year. There was a drop in the prevalence of the M184V mutation, from 80.6% in 2010 to 55.4% in 2016. For mutations associated with ITRNN, there was a stabilization of the prevalence of mutations. Among the major mutations for this class only the mutation at codon 188 showed a slight increase in the last year analyzed. Mutations of PI, there was a trend of decline of resistance mutations over the three years observed. Conclusion: In the presence of virologic failure of antiretroviral treatment, was observed that an excellent effectiveness of the Treatment switch guided by the genotyping test.