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M9480424.TXT
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1994-08-20
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Document 0424
DOCN M9480424
TI Didanosine resistance in HIV-infected patients switched from zidovudine
to didanosine monotherapy.
DT 9410
AU Kozal MJ; Kroodsma K; Winters MA; Shafer RW; Efron B; Katzenstein DA;
Merigan TC; Stanford University Medical Center, California 94305.
SO Ann Intern Med. 1994 Aug 15;121(4):263-8. Unique Identifier : AIDSLINE
MED/94311534
AB OBJECTIVE: To determine the frequency and pattern of development of
specific drug resistance mutations for human immunodeficiency virus
(HIV) reverse transcriptase in patients switched from zidovudine to
didanosine therapy and to examine the relation of the didanosine
resistance mutation at codon 74 of the HIV reverse-transcriptase gene to
CD4+ T-cell changes and virus burden. DESIGN: Retrospective analysis of
all patients enrolled at Stanford University in protocols where patients
were switched from zidovudine to didanosine monotherapy. SETTING: A
university hospital. PATIENTS: 64 patients infected with HIV who were
switched from zidovudine to didanosine monotherapy. Patients had the
acquired immunodeficiency syndrome (AIDS), AIDS-related complex, or were
asymptomatic (mean [+/- SD] starting CD4+ T-cell count of 129 +/- 88
cells/mm3). MEASUREMENTS: Serial serum specimens were tested for the
didanosine resistance mutation at codon 74 of the HIV
reverse-transcriptase gene and for a zidovudine resistance mutation at
codon 215 using selective polymerase chain reactions (PCR). Serum HIV
RNA levels were determined by quantitative PCR. CD4+ T-cell counts were
determined at serial time points. RESULTS: By 24 weeks of didanosine
therapy, the proportion of patients with the didanosine resistance
mutation at codon 74 increased from 0% to 56% (36 of 64). In contrast,
the proportion of patients with the zidovudine resistance mutation at
codon 215 decreased from 84% at the start to 59% after 24 weeks of
didanosine therapy (a 25% decrease, 95% lower CI, 15%; P < 0.0001).
Patients who developed the codon 74 mutation had a greater decrease in
CD4+ T cells after the development of the mutation than did patients
without the mutation (P < 0.001). In addition, after 24 weeks of
didanosine, patients who developed the codon 74 mutation had a greater
serum HIV RNA burden than patients who remained wild type (did not have
the mutation) at codon 74 (225,000 compared with 82,400 HIV RNA
copies/mL serum; P = 0.01). CONCLUSIONS: Among patients infected with
HIV who had advanced disease and were switched from zidovudine to
didanosine therapy, more than one half developed the didanosine
resistance mutation at codon 74 by 24 weeks of didanosine therapy.
Patients who developed the codon 74 mutation had a greater decline in
CD4+ T cells after the development of the mutation and had a greater
serum virus burden than did patients without the codon 74 mutation.
DE Codon/GENETICS Didanosine/*THERAPEUTIC USE Drug Resistance,
Microbial/GENETICS Genes, Viral/PHYSIOLOGY Human
HIV/ENZYMOLOGY/*GENETICS HIV Infections/*DRUG THERAPY/IMMUNOLOGY
Leukocyte Count Mutation Retrospective Studies Reverse
Transcriptase/*GENETICS RNA, Viral/GENETICS Support, U.S. Gov't,
P.H.S. T4 Lymphocytes Zidovudine/*THERAPEUTIC USE JOURNAL ARTICLE
SOURCE: National Library of Medicine. NOTICE: This material may be
protected by Copyright Law (Title 17, U.S.Code).