Mutations secondaires lors des traitements antirétroviraux des patients infectés par le VIH-1 du groupe M : significations cliniques de l'échappement viral

Virologic failure, defined as a persistent detectable viremia under antiretroviral therapy, is mainly driven by the emergence of antiretroviral Drug Resistance-Associated Mutations (DRAM) in the target genes of antiretroviral drugs. Identifying these mutations usually requires viremia above 1000 copies/mL, explaining why resistance data in persistent HIV-1 low-level viremia (LLV) (< 1000 copies / ml) are scarce in spite of the fact that this clinical situation concerns 5 to 10 % of treated HIV-infected individuals. In this work, we studied DRAM in 3 cohorts of HIV-1 infected patients, who experienced LLV (< 500 to 1000 copies/ml) under antiretroviral therapy, and then attempted to identify clinical and virologic factors associated to their emergence. For patients receiving first-line antiretroviral therapy, new DRAM are detected during LLV in 37% subjects, all in the reverse transcriptase gene except in the protease gene in one participant, and detection of new DRAM is associated with higher HIV-1 RNA levels during LLV. Integrase inhibitors resistance-associated mutations are newly detected in 7,7 % of pretreated patients with multi-resistant virus strains who experienced LLV while receiving raltegravir-containing therapy, with no factors significantly associated with their emergence identified. Finally in a third cohort of patients, heterogeneous according to their antiretroviral history and their viral population, new DRAM are detected in 30 % of subjects for both reverse transcriptase, protease and integrase inhibitors, without any factor associated to their emergence. So, new DRAM can be detected during LLV under antiretroviral therapy, whereas their type and their frequency vary according to the current antiretroviral regimen and the previous archived viral mutations. These data underline the potential interest of drug resistance genotyping in this setting, in order to be able to provide an early therapeutic optimization, the utility of which should be assessed in the future.