Trends in genotypic HIV-1 antiretroviral resistance between 2006 and 2012 in South African patients receiving first- and second-line antiretroviral treatment regimens

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dc.contributor.authorVan Zyl, Gert U.
dc.contributor.authorLiu, Tommy F.
dc.contributor.authorClaassen, Mathilda
dc.contributor.authorEngelbrecht, Susan
dc.contributor.authorDe Oliveira, Tulio
dc.contributor.authorPreiser, Wolfgang
dc.contributor.authorWood, Natasha T.
dc.contributor.authorTravers, Simon
dc.contributor.authorShafer, Robert W.
dc.date.accessioned2013-07-16T07:16:22Z
dc.date.available2013-07-16T07:16:22Z
dc.date.issued2013-06
dc.descriptionThe original publication is available at http://www.plosone.org/en_ZA
dc.descriptionPublication of this article was funded by the Stellenbosch University Open Access Fund.en_ZA
dc.descriptionBibliography
dc.description.abstractObjectives: South Africa’s national antiretroviral (ARV) treatment program expanded in 2010 to include the nucleoside reverse transcriptase (RT) inhibitors (NRTI) tenofovir (TDF) for adults and abacavir (ABC) for children. We investigated the associated changes in genotypic drug resistance patterns in patients with first-line ARV treatment failure since the introduction of these drugs, and protease inhibitor (PI) resistance patterns in patients who received ritonavir-boosted lopinavir (LPV/r)-containing therapy. Methods: We analysed ARV treatment histories and HIV-1 RT and protease mutations in plasma samples submitted to the Tygerberg Academic Hospital National Health Service Laboratory. Results: Between 2006 and 2012, 1,667 plasma samples from 1,416 ARV-treated patients, including 588 children and infants, were submitted for genotypic resistance testing. Compared with 720 recipients of a d4T or AZT-containing first-line regimen, the 153 recipients of a TDF-containing first-line regimen were more likely to have the RT mutations K65R (46% vs 4.0%; p<0.001), Y115F (10% vs. 0.6%; p<0.001), L74VI (8.5% vs. 1.8%; p<0.001), and K70EGQ (7.8% vs. 0.4%) and recipients of an ABC-containing first-line regimen were more likely to have K65R (17% vs 4.0%; p<0.001), Y115F (30% vs 0.6%; p<0.001), and L74VI (56% vs 1.8%; p<0.001). Among the 490 LPV/r recipients, 55 (11%) had ≥1 LPV-resistance mutations including 45 (9.6%) with intermediate or high-level LPV resistance. Low (20 patients) and intermediate (3 patients) darunavir (DRV) cross resistance was present in 23 (4.6%) patients. Conclusions: Among patients experiencing virological failure on a first-line regimen containing two NRTI plus one NNRTI, the use of TDF in adults and ABC in children was associated with an increase in four major non- thymidine analogue mutations. In a minority of patients, LPV/r-use was associated with intermediate or high-level LPV resistance with predominantly low-level DRV cross-resistance.en_ZA
dc.description.sponsorshipStellenbosch University Open Access Funden_ZA
dc.description.versionPublishers' Versionen_ZA
dc.format.extent8 p. : ill.
dc.identifier.citationVan Zyl, G. U. et al. 2013. Trends in Genotypic HIV-1 Antiretroviral Resistance between 2006 and 2012 in South African Patients Receiving First- and Second-Line Antiretroviral Treatment Regimens. PLoS ONE, 8(6): e67188, doi:10.1371/journal.pone.0067188.en_ZA
dc.identifier.issn1932-6203 (online)
dc.identifier.otherdoi:10.1371/journal.pone.0067188
dc.identifier.urihttp://hdl.handle.net/10019.1/85182
dc.language.isoen_USen_ZA
dc.publisherPublic Library of Science -- PLoSen_ZA
dc.rights.holderAuthors retain copyrighten_ZA
dc.subjectAntiretroviral resistance -- Testingen_ZA
dc.subjectThymidine analogue mutationsen_ZA
dc.subjectK65Ren_ZA
dc.subjectTenofoviren_ZA
dc.subjectAbacaviren_ZA
dc.subjectLopinaviren_ZA
dc.subjectStavudineen_ZA
dc.subjectProtease inhibitors -- Resistanceen_ZA
dc.subject.lcshAntoretroviral agents -- Therapeutic use -- Effectiveness -- Researchen_ZA
dc.subject.lcshHIV-positive persons -- Treatment -- South Africa -- Researchen-ZA
dc.titleTrends in genotypic HIV-1 antiretroviral resistance between 2006 and 2012 in South African patients receiving first- and second-line antiretroviral treatment regimensen_ZA
dc.typeArticleen_ZA
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