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Improved darunavir genotypic mutation score predicting treatment response for patients infected with HIV-1 subtype B and non-subtype B receiving a salvage regimen.

Type of publication Peer-reviewed
Publikationsform Original article (peer-reviewed)
Author De Luca Andrea, Flandre Philippe, Dunn David, Zazzi Maurizio, Wensing Annemarie, Santoro Maria Mercedes, Günthard Huldrych F, Wittkop Linda, Kordossis Theodoros, Garcia Federico, Castagna Antonella, Cozzi-Lepri Alessandro, Churchill Duncan, De Wit Stéphane, Brockmeyer Norbert H, Imaz Arkaitz, Mussini Cristina, Obel Niels, Perno Carlo Federico, Roca Bernardino, Reiss Peter, Schülter Eugen, Torti Carlo, van Sighem Ard, Zangerle Robert,
Project Swiss HIV Cohort Study (SHCS)
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Original article (peer-reviewed)

Journal The Journal of antimicrobial chemotherapy
Page(s) 1352 - 60
Title of proceedings The Journal of antimicrobial chemotherapy
DOI 10.1093/jac/dkv465

Open Access

Type of Open Access Repository (Green Open Access)


The objective of this study was to improve the prediction of the impact of HIV-1 protease mutations in different viral subtypes on virological response to darunavir. Darunavir-containing treatment change episodes (TCEs) in patients previously failing PIs were selected from large European databases. HIV-1 subtype B-infected patients were used as the derivation dataset and HIV-1 non-B-infected patients were used as the validation dataset. The adjusted association of each mutation with week 8 HIV RNA change from baseline was analysed by linear regression. A prediction model was derived based on best subset least squares estimation with mutational weights corresponding to regression coefficients. Virological outcome prediction accuracy was compared with that from existing genotypic resistance interpretation systems (GISs) (ANRS 2013, Rega 9.1.0 and HIVdb 7.0). TCEs were selected from 681 subtype B-infected and 199 non-B-infected adults. Accompanying drugs were NRTIs in 87%, NNRTIs in 27% and raltegravir or maraviroc or enfuvirtide in 53%. The prediction model included weighted protease mutations, HIV RNA, CD4 and activity of accompanying drugs. The model's association with week 8 HIV RNA change in the subtype B (derivation) set was R(2) = 0.47 [average squared error (ASE) = 0.67, P < 10(-6)]; in the non-B (validation) set, ASE was 0.91. Accuracy investigated by means of area under the receiver operating characteristic curves with a binary response (above the threshold value of HIV RNA reduction) showed that our final model outperformed models with existing interpretation systems in both training and validation sets. A model with a new darunavir-weighted mutation score outperformed existing GISs in both B and non-B subtypes in predicting virological response to darunavir.