Broad Phenotypic Cross-Resistance to Elvitegravir in HIV-Infected Patients Failing on Raltegravir-Containing Regimens

Hospital Carlos III, Madrid, Spain.
Antimicrobial Agents and Chemotherapy (Impact Factor: 4.48). 03/2012; 56(6):2873-8. DOI: 10.1128/AAC.06170-11
Source: PubMed


The failure of raltegravir (RAL) is generally associated with the selection of mutations at integrase position Y143, Q148, or N155. However, a relatively high proportion of failures occurs in the absence of these changes. Here, we report the phenotypic susceptibilities to RAL and elvitegravir (EVG) for a large group of HIV-infected patients failing on RAL-containing regimens. Plasma from HIV-infected individuals failing on RAL-containing regimens underwent genotypic and phenotypic resistance testing (Antivirogram v2.5.01; Virco). A control group of patients failing on other regimens was similarly tested. Sixty-one samples were analyzed, 40 of which belonged to patients failing on RAL-containing regimens. Full RAL susceptibility was found in 20/21 controls, while susceptibility to EVG was diminished in 8 subjects, with a median fold change (FC) of 2.5 (interquartile range [IQR], 2.1 to 3.1). Fourteen samples from patients with RAL failures showed diminished RAL susceptibility, with a median FC of 38.5 (IQR, 10.8 to 103.2). Primary integrase resistance mutations were found in 11 of these samples, displaying a median FC of 68.5 (IQR, 23.5 to 134.3). The remaining 3 samples showed a median FC of 2.5 (IQR, 2 to 2.7). EVG susceptibility was diminished in 19/40 samples from patients with RAL failures (median FC, 7.71 [IQR, 2.48 to 99.93]). Cross-resistance between RAL and EVG was high (R(2) = 0.8; P < 0.001), with drug susceptibility being more frequently reduced for EVG than for RAL (44.3% versus 24.6%; P = 0.035). Susceptibility to RAL and EVG is rarely affected in the absence of primary integrase resistance mutations. There is broad cross-resistance between RAL and EVG, which should preclude their sequential use. Resistance to EVG seems to be more frequent and might be more influenced by integrase variability.

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Available from: Federico Garcia, Mar 01, 2014
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    • "In contrast, the addition of H51Y to R263K was very detrimental to integrase strand-transfer activity [23]. Although the combination of M50I/R263K did not restore enzyme efficiency (Figure  3D), the M50I polymorphism partially restored integrase maximal activity to 92% of the WT Vmax for M50I/R263K (Figure  3B), as compared to approximately 20% for H51Y/R263K [21]. Since the M50I/R263K double mutant decreased integrase affinity for DNA compared to R263K alone (Figure  3C), an effect also observed with H51Y [23], this combination of mutations did not restore integration. "
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