Studies on the impact of antiretroviral treatment among people infected with HIV: role in residual viral replication, resistance to antiretrovirals and treatment failure

Abstract

1. Preliminary studies conducted by the team of Prof. Ricardo Sobhie Diaz, point out that combined strategies to (a) overcome residual HIV replication among people undergoing treatment, (b) overcome HIV latency and (c) eliminate HIV in so-called viral sanctuaries, have caused significant clinical impact and unexpected (NCT02961829) .1-19 Thus, initially pilot studies and proof of concept should be expanded to recruit a larger number of patients and strategies should be optimized to meet greater access to patients to complex processes, such as dendritic cell vaccine. .2. Studies analyzing the response to antiretroviral treatment with more modern regimens using the integrase inhibitor dolutegravir show that after one year of treatment, the response to antiretroviral treatment still accounts for 12% of patients with virological failure. Thus, the PNDST / AIDS and viral hepatitis of the Brazilian Ministry of Health asked Dr Diaz to analyze the results and understand the causes of the sub-optimal performance of a theoretically more effective antiretroviral regimen. Our preliminary analyzes show that the resistance transmitted to antiretrovirals has an index higher than expected in the portion of the population failing the initial treatment with the drug dolutegravir (unpublished data). In addition, unexpectedly and in contrast to what has been described in studies of registration of the drug dolutegravir, 20-23 resistance to this drug was detected in 4% of the patients evaluated by us. The understanding and design of appropriate intervention to mitigate virological failure and selection of viruses resistant to antiretrovirals in this group of patients, will offer a fundamental benefit to the portion of the Brazilian population initiating antiretroviral treatment (AU)