Resistencias genotípicas a los fármacos antirretrovirales en fracasos terapéuticos con pautas de alta eficacia
Genotypic resistance to antiretroviral drugs in patients with therapeutic failure to highly active antiretroviral therapy.
Félix Gutiérreza,e,
, José Moltóa, Clara Escolanoa, A. Moraa, Francisco Pasquaub, Joan Gregoric, Enrique. Nogueirad
Autor para correspondencia
fgutierrezr@medynet.com
Correspondencia: Dr. F. Gutiérrez Rodero. Unidad de Enfermedades Infecciosas. Hospital General Universitario de Elche. Huertos y Molinos, s/n. 03202 Elche. Alicante.
Correspondencia: Dr. F. Gutiérrez Rodero. Unidad de Enfermedades Infecciosas. Hospital General Universitario de Elche. Huertos y Molinos, s/n. 03202 Elche. Alicante.
a Unidad de Enfermedades Infecciosas. Servicio de Medicina Interna. Hospital General Universitario de Elche.
b Servicio de Medicina Interna. Hospital Comarcal de la Marina Baja. Villajoyosa.
c Servicio de Medicina Interna. Hospital Comarcal de la Vega Baja. Orihuela.
d Laboratorio de Diagnóstico Molecular DIENEI. Valencia.
e Departamento de Medicina. Universidad Miguel Hernández. Alicante.
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"etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Medicina Interna. Hospital Comarcal de la Marina Baja. Villajoyosa." "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Medicina Interna. Hospital Comarcal de la Vega Baja. Orihuela." "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] 3 => array:3 [ "entidad" => "Laboratorio de Diagnóstico Molecular DIENEI. Valencia." "etiqueta" => "<span class="elsevierStyleSup">d</span>" "identificador" => "aff0020" ] 4 => array:3 [ "entidad" => "Departamento de Medicina. Universidad Miguel Hernández. Alicante." "etiqueta" => "<span class="elsevierStyleSup">e</span>" "identificador" => "aff0025" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "*" "correspondencia" => "Correspondencia: Dr. F. Gutiérrez Rodero. Unidad de Enfermedades Infecciosas. Hospital General Universitario de Elche. Huertos y Molinos, s/n. 03202 Elche. Alicante." ] ] ] ] "titulosAlternativos" => array:1 [ "en" => array:1 [ "titulo" => "Genotypic resistance to antiretroviral drugs in patients with therapeutic failure to highly active antiretroviral therapy." ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "fechaRecibido" => "2000-03-14" "fechaAceptado" => "2000-07-25" "PalabrasClave" => array:1 [ "es" => array:1 [ 0 => array:4 [ "clase" => "keyword" "titulo" => "Palabras clave" "identificador" => "xpalclavsec223092" "palabras" => array:4 [ 0 => "Resistencias genotípicas" 1 => "Infección por el virus de la inmunodeficiencia humana" 2 => "Terapia antirretroviral" 3 => "Fracaso del tratamiento" ] ] ] ] "tieneResumen" => true "resumen" => array:2 [ "es" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Fundamento</span><p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Caracterizar las mutaciones asociadas con resistencia en fracasos virológicos con tratamientos antirretrovirales de gran actividad (TARGA).</p> <span class="elsevierStyleSectionTitle">Métodos</span><p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Estudio genotípico de la transcriptasa inversa y de la proteasa del VIH-1 en 33 pacien-tes con fracaso virológico, pese al buen cumplimiento del tratamiento.</p> <span class="elsevierStyleSectionTitle">Resultados</span><p id="spar0015" class="elsevierStyleSimplePara elsevierViewall">Se detectaron mutaciones en 32 de los 33 pacientes. En 27 (81,8%) se trataba de mutaciones primarias: en el gen de la transcriptasa inversa en 26 (78,8%) y en el de la protea-sa en 20 (60,6%). El 66,6% presentaba resistencias a dos fármacos y el 60,6% resistencias a fármacos de los dos principales grupos terapéuticos. En el momento del fracaso, el 72,7% de los pacientes recibía al menos un fármaco frente al que se identificaron genotipos resistentes; el 48,5%, dos fármacos, y el 21,2%, tres fármacos.</p> <span class="elsevierStyleSectionTitle">Conclusiones</span><p id="spar0020" class="elsevierStyleSimplePara elsevierViewall">La mayoría de los pacientes que fracasan pese al buen cumplimiento del trata-miento con TARGA presentan genotípos virales resistentes. Puede estar constituyéndose un reservorio de VIH multirresistentes que puede comprometer en el futuro el éxito del tratamiento antirretroviral.</p>" ] "en" => array:1 [ "resumen" => "<span class="elsevierStyleSectionTitle">Background</span><p id="spar0025" class="elsevierStyleSimplePara elsevierViewall">To assess genotypic resistance mutations in patients with virological failure with highly active antiretroviral therapy (HAART)</p> <span class="elsevierStyleSectionTitle">Methods</span><p id="spar0030" class="elsevierStyleSimplePara elsevierViewall">Genotyping of reverse transcriptase (RT) and protease (PRO) HIV-1 genes were ca-rried out in 33 adherent patients failing on HAART.</p> <span class="elsevierStyleSectionTitle">Results</span><p id="spar0035" class="elsevierStyleSimplePara elsevierViewall">Resistance mutations were found in 32 of the 33; 27 of them (81.8%) being primary mutations: 26 (78.8%) in the RT gene and 60 (60.6%) in the PRO gene. Overall, 66.6% had genotypic resistance to two drugs and 60.6% showed resistance to drugs belonging to the two main classes of antiretroviral drugs. At the time of treatment failure, 72.7% had on their thera-peutic regimen one antiretroviral drug to which they had resistance mutations, 48.5% had ge-notypic resistance to two drugs of the therapeutic regimen and 21.2% to three drugs.</p> <span class="elsevierStyleSectionTitle">Conclusions</span><p id="spar0040" class="elsevierStyleSimplePara elsevierViewall">Most adherent patients failing on HAART carry drug resistant genotypes. These pa-tients may constitute a reservoir of multidrug resistant HIV that may limit treatment options in the future.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "Referencias Bibliográficas" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1." 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| año/Mes | Html | Total | |
|---|---|---|---|
| 2024 Octubre | 0 | 6 | 6 |
| 2024 Septiembre | 0 | 3 | 3 |
| 2024 Agosto | 0 | 1 | 1 |
| 2024 Julio | 0 | 1 | 1 |
| 2024 Junio | 0 | 2 | 2 |
| 2024 Mayo | 0 | 1 | 1 |
| 2024 Abril | 0 | 3 | 3 |
| 2024 Marzo | 0 | 7 | 7 |
| 2024 Febrero | 0 | 3 | 3 |
| 2024 Enero | 0 | 4 | 4 |
| 2023 Diciembre | 0 | 10 | 10 |
| 2023 Noviembre | 0 | 3 | 3 |
| 2023 Octubre | 0 | 7 | 7 |
| 2023 Septiembre | 0 | 1 | 1 |
| 2023 Agosto | 0 | 14 | 14 |
| 2023 Julio | 0 | 6 | 6 |
| 2023 Junio | 0 | 1 | 1 |
| 2023 Mayo | 0 | 2 | 2 |
| 2023 Abril | 0 | 1 | 1 |
| 2023 Marzo | 0 | 10 | 10 |
| 2023 Febrero | 0 | 5 | 5 |
| 2023 Enero | 0 | 8 | 8 |
| 2022 Noviembre | 0 | 3 | 3 |
| 2022 Octubre | 0 | 3 | 3 |
| 2022 Septiembre | 0 | 3 | 3 |
| 2022 Julio | 0 | 1 | 1 |
| 2022 Mayo | 0 | 4 | 4 |
| 2022 Abril | 0 | 1 | 1 |
| 2022 Marzo | 0 | 3 | 3 |
| 2022 Febrero | 0 | 2 | 2 |
| 2022 Enero | 0 | 2 | 2 |
| 2021 Diciembre | 0 | 2 | 2 |
| 2021 Noviembre | 0 | 1 | 1 |
| 2021 Octubre | 0 | 2 | 2 |
| 2021 Septiembre | 0 | 1 | 1 |
| 2021 Agosto | 0 | 1 | 1 |
| 2021 Junio | 0 | 2 | 2 |
| 2021 Mayo | 0 | 1 | 1 |
| 2021 Abril | 0 | 2 | 2 |
| 2021 Febrero | 0 | 2 | 2 |
| 2021 Enero | 0 | 1 | 1 |
| 2020 Diciembre | 0 | 2 | 2 |
| 2020 Septiembre | 0 | 1 | 1 |
| 2020 Agosto | 0 | 3 | 3 |
| 2020 Julio | 0 | 2 | 2 |
| 2020 Junio | 0 | 1 | 1 |
| 2020 Abril | 0 | 2 | 2 |
| 2020 Marzo | 0 | 1 | 1 |
| 2020 Febrero | 0 | 2 | 2 |
| 2020 Enero | 0 | 4 | 4 |
| 2019 Diciembre | 0 | 6 | 6 |
| 2019 Noviembre | 0 | 1 | 1 |
| 2019 Septiembre | 0 | 1 | 1 |
| 2019 Agosto | 0 | 2 | 2 |
| 2019 Julio | 0 | 4 | 4 |
| 2019 Junio | 0 | 3 | 3 |
| 2019 Mayo | 0 | 24 | 24 |
| 2017 Octubre | 1 | 2 | 3 |
| 2017 Septiembre | 7 | 11 | 18 |
| 2017 Agosto | 4 | 5 | 9 |
| 2017 Julio | 4 | 3 | 7 |
| 2017 Junio | 11 | 12 | 23 |
| 2017 Mayo | 7 | 11 | 18 |
| 2017 Abril | 8 | 2 | 10 |
| 2017 Marzo | 9 | 19 | 28 |
| 2017 Febrero | 7 | 4 | 11 |
| 2017 Enero | 8 | 1 | 9 |
| 2016 Diciembre | 10 | 3 | 13 |
| 2016 Noviembre | 15 | 3 | 18 |
| 2016 Octubre | 42 | 3 | 45 |
| 2016 Septiembre | 13 | 2 | 15 |
| 2016 Agosto | 10 | 3 | 13 |
| 2016 Julio | 13 | 0 | 13 |
| 2016 Junio | 24 | 1 | 25 |
| 2016 Mayo | 11 | 1 | 12 |
| 2016 Abril | 10 | 2 | 12 |
| 2016 Marzo | 13 | 0 | 13 |
| 2016 Febrero | 7 | 1 | 8 |
| 2016 Enero | 16 | 0 | 16 |
| 2015 Diciembre | 15 | 0 | 15 |
| 2015 Noviembre | 16 | 0 | 16 |
| 2015 Octubre | 31 | 0 | 31 |
| 2015 Septiembre | 19 | 0 | 19 |
| 2015 Agosto | 10 | 0 | 10 |
| 2015 Julio | 9 | 0 | 9 |
| 2015 Junio | 8 | 0 | 8 |
| 2015 Mayo | 12 | 0 | 12 |
| 2015 Abril | 9 | 0 | 9 |
| 2015 Marzo | 10 | 0 | 10 |
| 2015 Febrero | 11 | 0 | 11 |
| 2015 Enero | 18 | 0 | 18 |
| 2014 Diciembre | 11 | 0 | 11 |
| 2014 Noviembre | 6 | 0 | 6 |
| 2014 Octubre | 7 | 0 | 7 |
| 2014 Septiembre | 10 | 0 | 10 |
| 2014 Agosto | 8 | 0 | 8 |
| 2014 Julio | 3 | 0 | 3 |
| 2014 Junio | 8 | 0 | 8 |
| 2014 Mayo | 3 | 0 | 3 |
| 2014 Abril | 2 | 0 | 2 |
| 2014 Marzo | 1 | 0 | 1 |
| 2014 Febrero | 1 | 0 | 1 |
| 2014 Enero | 6 | 0 | 6 |
| 2013 Noviembre | 6 | 0 | 6 |
| 2013 Octubre | 4 | 0 | 4 |
| 2013 Septiembre | 6 | 0 | 6 |
| 2013 Agosto | 7 | 0 | 7 |
| 2013 Julio | 1 | 0 | 1 |
| 2000 Octubre | 732 | 0 | 732 |
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