Author(s): Wallis CL, Mellors JW, Venter WD, Sanne I, Stevens W, Wallis CL, Mellors JW, Venter WD, Sanne I, Stevens W
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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.
This article was published in J Acquir Immune Defic Syndr
and referenced in Journal of AIDS & Clinical Research