Drug resistance in B and non-B subtypes amongst subjects recently diagnosed as primary/recent or chronic HIV-infected over the period 2013–2016: Impact on susceptibility to first-line strategies including integrase strand-transfer inhibitors

Objectives To characterize the prevalence of transmitted drug resistance mutations (TDRMs) by plasma analysis of 750 patients at the time of HIV diagnosis from January 1, 2013 to November 16, 2016 in the Veneto region (Italy), where all drugs included in the recommended first line therapies were prescribed, included integrase strand transfer inhibitors (InNSTI). Methods TDRMs were defined according to the Stanford HIV database algorithm. Results Subtype B was the most prevalent HIV clade (67.3%). A total of 92 patients (12.3%) were expected to be resistant to one drug at least, most with a single class mutation (60/68–88.2% in subtype B infected subjectsand 23/24–95.8% in non-B subjects) and affecting mainly NNRTIs. No significant differences were observed between the prevalence rates of TDRMs involving one or more drugs, except for the presence of E138A quite only in patients with B subtype and other NNRTI in subjects with non-B infection. The diagnosis of primary/recent infection was made in 73 patients (9.7%): they had almost only TDRMs involving a single class. Resistance to InSTI was studied in 484 subjects (53 with primary-recent infection), one patient had 143C in 2016, a total of thirteen 157Q mutations were detected (only one in primary/recent infection). Conclusions Only one major InSTI-TDRM was identified but monitoring of TDRMs should continue in the light of continuing presence of NNRTI-related mutation amongst newly diagnosed subjects, sometime impacting also to modern NNRTI drugs recommended in first-line therapy

[Drug-induced hepatotoxicity: clinical and biochemical features of 26 patients and a review of the literature].

Drug-induced hepatotoxicity: clinical and biochemical features of 26 patients and a review of the literature. Drug-induced hepatotoxicity is a major cause of iatrogenic diseases. More than 1200 compounds are involved and can reproduce the full range of hepatic disorders. Clinical and biochemical features of 26 patients (13 men and 13 women, mean age 62 years) observed during a 6 years period were reported. The potential hepatotoxicity of some herbal remedies are described, emphasizing the relevance of misconception that herbs are devoid of toxic potential because they are natural products. Meticulous taking of patient history, drug history with specific queries about ingestion of herbal and dietary supplements, and the exclusion of other causes of liver disease are important for the early detection of drug-induced hepatotoxicity and rapid discontinuation of suspected drug(s)