0001) (Table 1). Of the resistance mutations detected in the 61 patients with sequenced virus (of the 69 selected patients) at the therapy-naïve stage, 90% were present in CD4 cells and 66% PI3K inhibitor in the plasma. Fifty-five per cent of PR mutations (n=20) and 56% of RT mutations (n=9) were present simultaneously in CD4 cells and plasma. The proportion of mutations detected in the DNA and the proportion detected with standard RNA genotyping were statistically significantly different by the χ2 test (P<0.0001). We can therefore conclude that the difference in detected mutations is not attributable to chance. The kappa
coefficient was 0.71, which means that there was substantial agreement between the two methods in naïve patients [39]. One patient (patient 7) had the M46L PR key mutation selleck inhibitor in both plasma and cells, while patient 33 had the M46M/I mixed population only in the plasma (3% of 61 patients). The M46I or L mutation confers
high resistance to indinavir (IDV). Eight per cent of patients (n=61) had at least one RT mutation in the plasma while 15% had at least one RT resistance mutation in CD4 cells. Seven key mutations were detected in different patients (11.5% of the 61 patients and 10% of all included patients) and four of these (M184M/V, M184M/I, K103K/N and M46M/I) were only found in the cells (data shown for followed patients). For the 40 patients with follow-up samples (see Tables 2 and 4 below), three of the key mutations detected at the naïve stage were present in the RT and PR genes (M46L, M46M/I and K103K/N) of patients 7, 33 and 37. The K103K/N mixed population was not found in the plasma. One treatment-naïve patient
(patient 9 in Table 3) had virus with an RT resistance profile (67N, 70R and 219Q) in both CD4 cells and plasma. Global analysis of the resistance revealed identical results in 93% of CD4 cells and plasma. Twenty-five patients remained therapy naïve, and eight of these untreated patients were followed. The genotyping results for both the RT and the PR resistance mutations in plasma and CD4 cells from these patients are shown in Table 2. One of the eight patients had one revertant RT resistance mutation (T215L Thiamine-diphosphate kinase in patient 7), while two patients had a PR mutation, including one key mutation (M46L in patient 7). Although one patient (patient 3) showed a new key RT mutation (M184I) after 12 months, which was present only in the cells, follow-up data for resistance mutations in the plasma and CD4 cells demonstrated stable mutation patterns. Patients 3 and 7 showed mutations in the second sample that were not detected in the first sample; this was probably a result of the known low sensitivity of direct sequencing for detecting minor populations. The genotyping results for RT and PR resistance mutations in plasma and CD4 cells from the NNRTI-treated patients are shown in Table 3.