PREVALENCE OF DRUG RESISTANCE AND ASSOCIATED MUTATIONSIN HIV-POSITIVE PUERTO RICANS: SEX VARIATIONS
Introduction: A cross sectional study was
Luis A. Cubano, PhD; Lycely del C. Sepu´lveda-Torres, PhD;
Greychan Sosa, BS; Nawal Boukli, PhD; Rafaela Robles, EdD; Jose´ W.
evolution of HIV-1 infection in Puerto Rico by
Rodriguez, PhD; Lourdes Guzma´n, MT; Eddy Rı´os-Olivares, PhD
monitoring the expression of antiretroviralresistance-associated mutations.
Methods: Samples were analyzed by using the
Results: Mutations in the HIV-1 virus were
impede viral reproduction is the presence
women. Of these, 75.1% of men and 72.4% of
women had HIV-1 with resistance to at least
one medication. The average number of HIV
mutations was 6.1 in men and 5.3 in women. In 2002 and 2003, strains were most frequent-
ly resistant to the antiretroviral drugs zalcita-
specificity for the RTIs and PIs have been
bine, lamivudine and didanosine, while in
2004, strains were most frequently resistant to
zalcitabine, lamivudine, and efavirenz. The
resulting in reduced treatment efficacy.4
T215Y, and M41L. The most prevalent muta-
tions in the protease gene were L63P, M36I,
lence of genotypic mutations in asample of Puerto Ricans infected with
Conclusions: Significant differences between
men and women were recorded in the levels
of HIV-1 expressed mutations and resistance.
When comparing these results with data from
2000 and 2001, results indicate that expres-
sion of resistant mutations has remainedconstant. (Ethn Dis. 2008;18[Suppl 2]:S2-132–
lence, especially details about exposure to
antiretroviral therapy, which is directly
expand the data obtained by the study.
transcriptase is essential for viral repli-
munology (LAC, NB, JWR, LG, ERO), Centerfor Addiction Studies (RR), Universidad
cation and is required for the conversion
Metropolitana, San Juan (LST); Department
of Natural Sciences, Universidad de Puerto
resistance is a major factor in treatment
798-3001 x 2150; 787-740-4390; luis. cubano@uccaribe.edu
proteins that are necessary for the virus
Ethnicity & Disease, Volume 18, Spring 2008
DRUG RESISTANCE IN HIV-POSITIVE PUERTO RICANS - Cubano et al
and women in rates of viral resistance to
highest rate of resistance to antiretrovi-
resistance to ritonavir (P5.04), nelfina-
reverse transcriptase resistance-associat-
analysis, and x2 test was performed.
Statistical significance was set at P#.05.
transcriptase-specific resistant mutations
Ethnicity & Disease, Volume 18, Spring 2008
DRUG RESISTANCE IN HIV-POSITIVE PUERTO RICANS - Cubano et al
Table 1. Rates of HIV-1 resistance to antiretroviral drugs, Puerto Rico, 2002–2004
* Significant difference between men and women.
(24.1%), L10I (22.7%), and A71V(18.1%). Significant differences were
Table 2. Frequency of the 10 most prevalent resistance mutations in HIV-1 reverse transcriptase, Puerto Rico, 2002–2004
* Significant difference between men and women.
Ethnicity & Disease, Volume 18, Spring 2008
DRUG RESISTANCE IN HIV-POSITIVE PUERTO RICANS - Cubano et al
Table 3. Frequency of the 10 most prevalent resistance mutations in HIV-1 protease, Puerto Rico, 2002–2004
* Significant difference between men and women.
resistance to various antiretroviral drugs
infected with a drug-resistant strain. By
average of five full years of data will help
was conducted with only 80 subjects.
pretation (antiretroviral resistance). It is
drugs in all four categories: nucleoside/
protease inhibitors, and integrase inhib-
tional variation makes clinical decisions
challenging.19 Therefore, it is necessary
resistance mutations to assist physicians
were resistant to at least one drug in our
versions of the software that result from
partners with virulent mutated strains.
reduction in mortality, the high rates of
Ethnicity & Disease, Volume 18, Spring 2008
DRUG RESISTANCE IN HIV-POSITIVE PUERTO RICANS - Cubano et al
after starting antiretroviral therapy in routine
14. Torres B, Valle´s V, Rı´os-Olivares E. Prevalence
clinical practice. AIDS. 2005;19(5):487–494.
of primary and secondary resistance mutations
5. Robles RR, Matos TD, Colon HM, et al.
to antiretroviral drug in a population of Puerto
Ricans infected with HIV. P R Health Sci J.
Puerto Rico. P R Health Sci J. 2003;22(4):
point out possible differences in efficacy
15. Richman DD, Morton SC, Wrin T, et al. The
prevalence of antiretroviral drug resistance in
these possible differences in efficacy will
the United States. AIDS. 2004;18(10):1393–1401.
lead to better treatments, reducing health
HIV/AIDS epidemic in Puerto Rico. RevPanam Salud Publica. 2000;7(6):377–383.
16. Noel RJ Jr, Chaudhary S, Rodriguez N, et al.
7. Gomez MA, Velazquez M, Hunter RF. Outline
Phylogenetic relationships between Puerto
of the Human Retrovirus Registry: profile of a
Rico and continental USA HIV-1 pol sequenc-
Puerto Rican HIV-infected population. Bol
es: a shared HIV-1 infection. Cell Mol Biol.
Asoc Med P R. 1997;89(7–9):111–116.
8. Matos TD, Robles RR, Sahai H, et al. HIV
17. Little SJ, Holte S, Routy JP, et al. Antiretro-
risk behaviors and alcohol intoxication among
viral-drug resistance among patients recently
injection drug users in Puerto Rico. Drug
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9. Reyes JC, Robles RR, Colon HM, et al.
18. Napravnik S, Edwards D, Stewart P, et al.
1. Centers for Disease Control and Prevention.
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HIV/AIDS Surveillance Report. Vol. 15.
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20. Kuyper LM, Wood E, Montaner JS, et al.
HIV-1 protease. Prog Biophys Mol Biol. 2005;
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Ethnicity & Disease, Volume 18, Spring 2008
SLEEP DISORDERS Nearly all of my head-injured patients have some form of a sleep disorder. This is rather confusing because people with head injuries can also have a fatigue disorder. You would think people with a fatigue disorder would want to sleep all the time or would sleep like rocks. You can, however, have both problems. First, let's recognize what happens with a typical sleep disorder
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