Variants minoritaires du VIH-1 : détection, quantification et implications cliniques

Success to antiretroviral HIV treatment is reduced by the presence of resistant variants. These variants can be present at very low level in the viral population and not detected by conventional assay. High throughput sequencing technologies allow the detection of minority variants present at less than 20 % and their quantification, easily and rapidly. However, the influence of minority variants on the treatment response must be determined. The detection of minority variants resistant to non-nucleoside reverse transcriptase inhibitors (NNRTI) is associated to an increased risk of virological failure in patients with an NNRTI containing treatment. The detection of X4 using variants is also associated to an increased risk of virological failure in patients treated with a CCR5 antagonist. This association was not observed with other antiretroviral classes. Although, these data need to be confirmed in prospective studies, detection of minority variants could help in optimizing NNRTI and CCR5 antagonist containing treatment.