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

Détails

ID Serval
serval:BIB_DE6CA2A8CFD5
Type
Article: article d'un périodique ou d'un magazine.
Collection
Publications
Institution
Titre
Emergence of HIV-1 drug resistance in previously untreated patients initiating combination antiretroviral treatment: a comparison of different regimen types.
Périodique
Archives of Internal Medicine
Auteur(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
Statut éditorial
Publié
Date de publication
2007
Peer-reviewed
Oui
Volume
167
Numéro
16
Pages
1782-1790
Langue
anglais
Notes
Journal Article Research Support, Non-U.S. Gov't --- Old month value: Sep 10
Résumé
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.
Mots-clé
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
Oui
Création de la notice
29/01/2008 9:52
Dernière modification de la notice
20/08/2019 17:03
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