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Minor HIV protease mutations point to antiretroviral failure
  By David Douglas
NEW YORK (Reuters Health) - Minor mutations of 36I and 101/V in HIV protease can predict the appearance of a mutation associated with resistance to protease inhibitors (PIs), European researchers report in the June 1st issue of the Journal of Infectious Diseases.
Dr. Carlo Federico Perno of the University of Rome Tor Vergata and colleagues, who note that 36I is seen in about 25% of HIV clade B and more than 80% of non-clade B viruses, came to this conclusion after studying 93 previously drug-naive patients who experienced failure of their first PI -based antiretroviral regimens.
The 90M primary mutation is associated with different levels of resistance to all current PIs, say the investigators, and identifying factors associated with its appearance "is particularly relevant from the clinical standpoint."
The findings, Dr. Perno told Reuters Health, could be eventually used in developing therapeutic strategies as well as "implementation of the diagnostic algorithms that are used in clinical practice for a better utilization of the inhibitors of HIV replication."
He and his colleagues conclude that if their results are confirmed, "use of resistance testing in chronically-infected drug naive patients before initiation of therapy should become the rule."
J Infect Dis 2004;189:1983-1987.


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