Emergence of HIV-1 drug resistance in previously untreated patients initiating combination antiretroviral treatment: a comparison of different regimen types.

Details

Serval ID
serval:BIB_DE6CA2A8CFD5
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Emergence of HIV-1 drug resistance in previously untreated patients initiating combination antiretroviral treatment: a comparison of different regimen types.
Journal
Archives of Internal Medicine
Author(s)
von Wyl V., Yerly S., Böni J., Bürgisser P., Klimkait T., Battegay M., Furrer H., Telenti A., Hirschel B., Vernazza P.L., Bernasconi E., Rickenbach M., Perrin L., Ledergerber B., Günthard H.F.
ISSN
0003-9926
Publication state
Published
Issued date
2007
Peer-reviewed
Oui
Volume
167
Number
16
Pages
1782-1790
Language
english
Notes
Journal Article Research Support, Non-U.S. Gov't --- Old month value: Sep 10
Abstract
BACKGROUND: Standard first-line combination antiretroviral treatment (cART) against human immunodeficiency virus 1 (HIV-1) contains either a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r). Differences between these regimen types in the extent of the emergence of drug resistance on virological failure and the implications for further treatment options have rarely been assessed. METHODS: We investigated virological outcomes in patients from the Swiss HIV Cohort Study initiating cART between January 1, 1999, and December 31, 2005, with an unboosted PI, a PI/r, or an NNRTI and compared genotypic drug resistance patterns among these groups at treatment failure. RESULTS: A total of 489 patients started cART with a PI, 518 with a PI/r, and 805 with an NNRTI. A total of 177 virological failures were observed (108 [22%] PI failures, 24 [5%] PI/r failures, and 45 [6%] NNRTI failures). The failure rate was highest in the PI group (10.3 per 100 person-years; 95% confidence interval [CI], 8.5-12.4). No difference was seen between patients taking a PI/r (2.7; 95% CI, 1.8-4.0) and those taking an NNRTI (2.4; 95% CI, 1.8-3.3). Genotypic test results were available for 142 (80%) of the patients with a virological treatment failure. Resistance mutations were found in 84% (95% CI, 75%-92%) of patients taking a PI, 30% (95% CI, 12%-54%) of patients taking a PI/r, and 66% (95% CI, 49%-80%) of patients taking an NNRTI (P < .001). Multidrug resistance occurred almost exclusively as resistance against lamivudine-emtricitabine and the group-specific third drug and was observed in 17% (95% CI, 9%-26%) of patients taking a PI, 10% (95% CI, 0.1%-32%) of patients taking a PI/r, and 50% (95% CI, 33%-67%) of patients taking an NNRTI (P < .001). CONCLUSIONS: Regimens that contained a PI/r or an NNRTI exhibited similar potency as first-line regimens. However, the use of a PI/r led to less resistance in case of virological failure, preserving more drug options for the future.
Keywords
Adult, Antiretroviral Therapy, Highly Active, Confidence Intervals, Drug Resistance, Multiple, Viral, Female, Follow-Up Studies, HIV Infections, HIV Protease Inhibitors, HIV-1, Humans, Incidence, Male, Middle Aged, Molecular Sequence Data, RNA, Viral, Retrospective Studies, Reverse Transcriptase Inhibitors, Ritonavir, Switzerland, Treatment Outcome
Pubmed
Web of science
Open Access
Yes
Create date
29/01/2008 9:52
Last modification date
20/08/2019 17:03
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