Antiretroviral resistance patterns and factors associated with resistance in adult patients failing NNRTI-based regimens in the western cape, South Africa

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dc.contributor.authorvan Zyl G.U.
dc.contributor.authorvan der Merwe L.
dc.contributor.authorClaassen M.
dc.contributor.authorZeier M.
dc.contributor.authorPreiser W.
dc.date.accessioned2011-10-13T16:58:20Z
dc.date.available2011-10-13T16:58:20Z
dc.date.issued2011
dc.description.abstractAntiretroviral drug resistance in patients failing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line combination antiretroviral treatment (ART) is influenced by: regimen choice, HIV-1 subtype, detection of and response to therapy failure. In order to describe resistance patterns by genotypic testing, at the time of first-line ART failure and to describe associations with having M184I/V, K65R, three or more thymidine analog mutations (TAMs) and etravirine (ETV) resistance, the prevalence of antiretroviral drug resistance associated mutations in a cross-sectional study, at two South African public health clinic settings, at the time of virologic failure (HIV-1 RNA load >400copies/ml) are described. Also reported are associations of therapy choice, prolonged virologic failure, and concurrent HIV viral load and CD4 count with the presence of M184I/V, TAMs, K65R, and resistance to ETV. Of 167 adult patients with virologic failure on first-line ART, 28 (17%) had no resistance, 137 (82%) had NNRTI resistance, 101 (60%) M184I/V, 20 (12%) TAMs, of which 4 had 3 or more TAMs, and 7 (4%) had K65R, of which 6 were on D4T and one on AZT. A prolonged estimated period of failure was associated with having ≥3 TAMs. Patients treated with nevirapine (NVP) were more likely to have ETV resistance than those treated with efavirenz (EFV). Major protease inhibitor mutations were not detected. A delayed response to ART failure may risk accumulation of TAMs in patients on an NNRTI-based regimen. The use of NVP rather than EFV was associated with ETV resistance. © 2011 Wiley-Liss, Inc..
dc.description.versionArticle
dc.identifier.citationJournal of Medical Virology
dc.identifier.citation83
dc.identifier.citation10
dc.identifier.citationhttp://www.scopus.com/inward/record.url?eid=2-s2.0-80051589041&partnerID=40&md5=4295d92ae4f4ce469179592e10c82403
dc.identifier.issn1466615
dc.identifier.other10.1002/jmv.22189
dc.identifier.urihttp://hdl.handle.net/10019.1/16687
dc.subjectAntiretroviral drug resistance
dc.subjectEtravirine associated mutations
dc.subjectHIV-1 subtype C
dc.subjectNevirapine
dc.subjectThymidine analog mutations
dc.subjectCD4 antigen
dc.subjectefavirenz
dc.subjectetravirine
dc.subjectlamivudine
dc.subjectnevirapine
dc.subjectnonnucleoside reverse transcriptase inhibitor
dc.subjectstavudine
dc.subjecttenofovir
dc.subjectthymidine
dc.subjectvirus RNA
dc.subjectzidovudine
dc.subjectadult
dc.subjectarticle
dc.subjectCD4 lymphocyte count
dc.subjectcross resistance
dc.subjectcross-sectional study
dc.subjectfemale
dc.subjectgenotype
dc.subjecthighly active antiretroviral therapy
dc.subjecthuman
dc.subjectHuman immunodeficiency virus 1
dc.subjectHuman immunodeficiency virus 1 infection
dc.subjectmajor clinical study
dc.subjectmale
dc.subjectnonhuman
dc.subjectSouth Africa
dc.subjecttreatment failure
dc.subjectvirus load
dc.subjectvirus mutation
dc.subjectvirus resistance
dc.subjectvirus strain
dc.titleAntiretroviral resistance patterns and factors associated with resistance in adult patients failing NNRTI-based regimens in the western cape, South Africa
dc.typeArticle
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