Prevalence and Characteristics of Multinucleoside-Resistant Human Immunodeficiency Virus Type 1 Among European Patients Receiving Combinations of Nucleoside Analogues [van Vaerenbergh K, et al. AAC 2000; 44: 2109]: The investigators determined the prevalence of Q151M and T69SSS, mutations that confer multinucleoside resistance, in 363 samples collected between 1991 and 1997 from persons exposed to two or more nucleosides and 274 control patients exposed to no antiretroviral agents or one NRTI. There were six (1.6%) samples showing the Q151M mutation and two (0.5%) showing the T69SSS mutation among the nucleoside-experienced patients. Neither of these resistant mutations were noted in the controls. Patients who had multinucleoside resistance showed poor response to treatment in vivo. The authors conclude that these mutations are infrequent in Europe, but when present they seriously limit treatment options.
Comment: This paper calls attention to multinucleoside resistance patterns that are generally feared. It is reassuring to know that their prevalence is relatively low despite a population that often received prolonged courses of one or two nucleosides from 1991 to 1997. Nevertheless, this is a mutation which could seriously limit current treatment options if prevalence increases. posted 8/29/2000