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J Acquir Immune Defic Syndr. 2010 Apr 1;53(4):480-4. doi: 10.1097/QAI.0b013e3181bc478b.

Varied patterns of HIV-1 drug resistance on failing first-line antiretroviral therapy in South Africa.

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1
Department of Molecular Medicine and Haematology, University of the Witwatersrand, Johannesburg, South Africa. cwallis@mweb.co.za

Abstract

BACKGROUND:

The South African national antiretroviral therapy roll-out program is entering its sixth year, with over 570,000 adults accessing treatment. HIV-1 drug resistance is a potential consequence of therapy. This study determined the pattern of HIV-1 drug resistance mutations after failure of first-line treatment regimens in South Africa.

METHODS:

Two hundred and twenty-six patients virologically failing first-line regimens were studied to determine resistance patterns.

RESULTS:

The most common reverse transcriptase mutation was M184V/I (72%; n = 163); 11% of patients (n = 25) had only nonnucleoside reverse transcriptase inhibitor (NNRTI) mutations and 17% (n = 38) had no known resistance mutations. The K65R mutation was detected in 4%. The frequency of thymidine analog mutations was significantly higher with azidothymidine-containing (31 of 57) than stavudine-containing regimens (39 of 169; P < 0.001). The Y181C mutation was more frequent with failure of nevirapine (NVP)-containing (26%) than efavirenz (EFV)-containing therapy (3%; P < 0.001). The V106M mutation was more frequent with EFV (30%) than NVP (4%; P = 0.012).

CONCLUSIONS:

HIV-1 drug resistance patterns varied broadly after failure of first-line therapy, ranging from no known resistance mutations (17%) to multinucleoside reverse transcriptase inhibitor and NNRTI resistance (23%). NNRTI mutation profiles differed for patients on EFV- compared with NVP-containing regimens. Overall, these findings suggest that HIV-1 drug resistance testing would be useful in identifying most appropriate second-line regimens.

PMID:
19801944
DOI:
10.1097/QAI.0b013e3181bc478b
[Indexed for MEDLINE]
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