serval:BIB_7079852086EE
Adherence as a predictor of the development of class-specific resistance mutations: the Swiss HIV Cohort Study.
10.1371/journal.pone.0077691
000326019400125
24147057
von Wyl
V.
author
Klimkait
T.
author
Yerly
S.
author
Nicca
D.
author
Furrer
H.
author
Cavassini
M.
author
Calmy
A.
author
Bernasconi
E.
author
Böni
J.
author
Aubert
V.
author
Günthard
H.F.
author
Bucher
H.C.
author
Glass
T.R.
author
Swiss HIV Cohort Study
contributor
Aubert
V.
contributor
Barth
J.
contributor
Battegay
M.
contributor
Bernasconi
E.
contributor
Böni
J.
contributor
Bucher
HC.
contributor
Burton-Jeangros
C.
contributor
Calmy
A.
contributor
Cavassini
M.
contributor
Egger
M.
contributor
Elzi
L.
contributor
Fehr
J.
contributor
Fellay
J.
contributor
Furrer
H.
contributor
Fux
CA.
contributor
Gorgievski
M.
contributor
Günthard
H.
contributor
Haerry
D.
contributor
Hasse
B.
contributor
Hirsch
HH.
contributor
Hösli
I.
contributor
Kahlert
C.
contributor
Kaiser
L.
contributor
Keiser
O.
contributor
Klimkait
T.
contributor
Kouyos
R.
contributor
Kovari
H.
contributor
Ledergerber
B.
contributor
Martinetti
G.
contributor
Martinez de Tejada
B.
contributor
Metzner
K.
contributor
Müller
N.
contributor
Nadal
D.
contributor
Pantaleo
G.
contributor
Rauch
A.
contributor
Regenass
S.
contributor
Rickenbach
M.
contributor
Rudin
C.
contributor
Schmid
P.
contributor
Schultze
D.
contributor
Schöni-Affolter
F.
contributor
Schüpbach
J.
contributor
Speck
R.
contributor
Staehelin
C.
contributor
Tarr
P.
contributor
Telenti
A.
contributor
Trkola
A.
contributor
Vernazza
P.
contributor
Weber
R.
contributor
Yerly
S.
contributor
article
2013
Plos One
1932-6203
1932-6203
journal
8
10
e77691
BACKGROUND: Non-adherence is one of the strongest predictors of therapeutic failure in HIV-positive patients. Virologic failure with subsequent emergence of resistance reduces future treatment options and long-term clinical success.
METHODS: Prospective observational cohort study including patients starting new class of antiretroviral therapy (ART) between 2003 and 2010. Participants were naïve to ART class and completed ≥1 adherence questionnaire prior to resistance testing. Outcomes were development of any IAS-USA, class-specific, or M184V mutations. Associations between adherence and resistance were estimated using logistic regression models stratified by ART class.
RESULTS: Of 314 included individuals, 162 started NNRTI and 152 a PI/r regimen. Adherence was similar between groups with 85% reporting adherence ≥95%. Number of new mutations increased with increasing non-adherence. In NNRTI group, multivariable models indicated a significant linear association in odds of developing IAS-USA (odds ratio (OR) 1.66, 95% confidence interval (CI): 1.04-2.67) or class-specific (OR 1.65, 95% CI: 1.00-2.70) mutations. Levels of drug resistance were considerably lower in PI/r group and adherence was only significantly associated with M184V mutations (OR 8.38, 95% CI: 1.26-55.70). Adherence was significantly associated with HIV RNA in PI/r but not NNRTI regimens.
CONCLUSION: Therapies containing PI/r appear more forgiving to incomplete adherence compared with NNRTI regimens, which allow higher levels of resistance, even with adherence above 95%. However, in failing PI/r regimens good adherence may prevent accumulation of further resistance mutations and therefore help to preserve future drug options. In contrast, adherence levels have little impact on NNRTI treatments once the first mutations have emerged.
eng
60_published
true
Publication types: Journal Article ; Research Support, Non-U.S. Gov'tPublication Status: epublish
University of Lausanne
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