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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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HIV-1 Drug Resistance Profiles in Children and Adults With Viral Load of < 50 Copies/mL Receiving Combination Therapy [Hemankova M, et al. JAMA 2001; 286: 196]: This is a report on a study from Hopkins that was designed to determine the resistance mutations of HIV-1 strains detected with low level viremia, defined as <50 c/mL during HAART. Viral sequences from 8 patients were amplified, and this showed resistance mutations associated only with archived pre-HAART virus reflecting earlier treatment; HAART-selected mutations were seen only in patients with viral loads >400 c/mL.
Comment: The study is unique in showing the ability to amplify HIV in patients with viral loads <50 c/mL to measure resistance mutations. The results showed that new mutations attributed to selection by the HAART regimen did not occur, although there were mutations reflecting antiretroviral therapy that preceded HAART. This paper supports the conclusions of the clinical study of Havlir and colleagues that appears in the same issue [JAMA 2001;286:171] in showing that low level viremia is not associated with selection of resistant strains. It also shows the potential utility of this technology as a future method to determine resistance patterns despite low-level viremia when clinical decisions would benefit from this information.
posted 7/17/2001





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