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Agreement degree between two genotype interpretation systems, tipranavir (TPV) and darunavir (DRV) validated weighted scores (WS) and Stanford HIVdb program
M.J. Pérez Elías1, C. Gutierrez1, J.L. Casado1, A. Moreno1, D. Lopez1, E. Delsol1, D. Fernando1, I. Garcia-Arata2, A. Muriel3, E. Garcia3, B. Hernandez1, M.A. Rodriguez3, J.C. Galan3, S. Moreno1
1Hospital Ramón y Cajal, Infectious Diseases, Madrid, Spain, 2Hospital de Fuenlabrada, Madrid, Spain, 3Hospital Ramon y Cajal, Madrid, Spain
Background: Current salvage therapy is mainly based in new protease inhibitors (PI) with activity against already PI resistance HIV strains, TPV and DRV. Disagreement between different genotypic interpretation systems may impact in treatment design and efficacy.
Material y Methods: Kappa test and Landis scale were applied to evaluate agreement degree between TPV and DRV validated WS (TPV -J Scherer- and DRV -Meyer S-) and Stanford HIVdb programme (STdb). STdb values were categorized as susceptible (S), intermediate (I) and resistant (R); and then in (S) and (I/R).
Results: From 04/01 to 04/08, 141 treatment episodes from 75 patients were included: 61% male, 43 year old, 38% former IDU, exposed to antiretroviral drugs for a median of 334 months, with baseline HIV-RNA and CD4 cell count of 4.2 log and 253 cell/mcL. Resistance for TPV interpreted by STdb was (47.5 %, S) (31.9%, I) y (20.6%, R) and by its WS (52.5%, S) (46.8%, I) y (0.7%, R), whereas for DRV by STdb was (63.1%, S) (36.2%, I) and (0.7%, R) and by its WS (62%, S) (37%, I) and (0%, R). Agreement degree for TPV values was (37,6% both S), (37,6% both I/R), (9.9% S by STdb and I/R by WS) and (14.9% I/R by STdb and S by WS), kappa 0.5 (moderate), and for DRV values (56% both S), (30,5% both I/R), (7.1% S by STdb and I/R by WS) and (16.4% I/R by STdb and S by WS), kappa 0.7 (substantial). In 65 and 45 patients receiving either TPV or DRV neither baseline individual resistance nor GSS predicted VR.
Conclusions: Using TPV and DRV WS few patients were fully resistance. For TPV an important disagreement was found between STdb and its WS, while this is lower for DRV. Higher populations are needed to explore the impact of genotype interpretation and viral response.
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