Open AccessGenotypic Drug Resistance and Cause of Death in HIV-Infected Persons Who Died in 1999
Author(s) -
Nele K. Beinker,
Douglas L. Mayers,
Christoph Lange,
Hernán Valdez,
Jodi R. Sitkins,
Lori A. Lemonnier,
Tanvir K. Chowdhry,
Michael M. Lederman
Publication year - 2001
Publication title -
journal of acquired immune deficiency syndromes
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.162
H-Index - 157
eISSN - 1944-7884
pISSN - 1525-4135
DOI - 10.1097/00042560-200111010-00007
Subject(s) - drug resistance , medicine , reverse transcriptase , virus , virology , multiple drug resistance , viral load , genotype , cause of death , human immunodeficiency virus (hiv) , sida , antiretroviral therapy , drug , immunology , lentivirus , viral disease , biology , polymerase chain reaction , pharmacology , disease , biochemistry , gene , microbiology and biotechnology
We analyzed the relationship between viral drug resistance and causes of death in 29 HIV-1-infected patients who had been followed in an HIV-outpatient clinic and died in 1999. Six patients (21%) died with plasma HIV-RNA levels <1000 copies/ml. Seven (24%) died with wild-type (WT) virus in plasma, 6 (21%) had reverse transcriptase (RT) mutations only, 10 (34%) had multidrug-resistant (MDR) virus. The causes of death were not differently distributed among these groups; however, 8 of 16 patients (50%) with resistant viruses died of end-organ failure versus 2 of 7 patients (29%) with WT virus. Seventeen of 32 patients (53%) were thought by their physicians to be noncompliant with prescribed therapy. Major resistance mutations to antiretroviral drugs were present in viruses from at least 55% of our HIV-1-infected patients who died in 1999. Nonetheless, deaths also occurred among patients with well-controlled HIV infection and among patients with WT virus in plasma. Infections related to incomplete immune restoration, inability to maintain suppressive antiretroviral drug levels, and end-organ failures all contribute to mortalities in the era of highly active antiretroviral therapy.