A cluster of patients with a recombinant B/F HIV-1 infection: epidemiological, clinical and virological aspects.
Résumé
Background. Migratory processes determined changes in HIV epidemiology with an increasing role of non-B subtypes. Sequencing and phylogenetic analyses in our Outpatient cohort described a B/F recombinant clade with anomalous breakpoints that didn't allow to classify it as CRF12_BF. We assessed epidemiological, immuno-virological and clinical management of these patients receiving non-nucleoside reverse transcriptase inhibitor (NNRTI)- or protease inhibitor (PI)-based regimens. Methods. Our Outpatient Cohort was tested to identify non-B isolates; among them, a group with a B/F recombinant viral strain was the largest. Clinical, immunological and virological outcome in treated subjects was evaluated. Results. We found 13 subjects with a B/F recombinant strain (prevalence 2.4%). The immuno-virological mismatch led to a mean delay of 6.8 months in treatment initiation. Therapy was started in 9 cases. Both NNRTI- and PI-based regimens reached a full virological suppression after 36 weeks of treatment; PI proved to be more effective in terms of immunological recovery (+1041 cell/mmc versus +260). Conclusions. The diffusion of non-B subtypes is increasing worldwide but their response to treatment is still poor known. PIs and NNRTIs are effective for this B/F recombinant form: further analyses are needed to recognize more effectively these viral strains and to establish their best management.
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