Loading…

Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa

BACKGROUND: Emergence of HIV-1 drug resistance is at times an inevitable and anticipated consequence of antiretroviral therapy (ART) failure. We examined drug resistance patterns and virus re-suppression among subtype C-infected South African patients receiving first-line ART. METHODS: Treatment rec...

Full description

Saved in:
Bibliographic Details
Published in:Journal of AIDS & clinical research 2011-02, Vol.2 (117)
Main Authors: El-Khatib, Ziad, Delong, Allison K, Katzenstein, David, Ekstrom, Anna Mia, Ledwaba, Johanna, Mohapi, Lerato, Laher, Fatima, Petzold, Max, Morris, Lynn, Kantor, Rami
Format: Article
Language:English
Citations: Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
cited_by cdi_FETCH-LOGICAL-c3527-1db987ca5bf5839ca54d4a79f85de696fb033b64a431b1aaf721494e63d9c1513
cites
container_end_page
container_issue 117
container_start_page
container_title Journal of AIDS & clinical research
container_volume 2
creator El-Khatib, Ziad
Delong, Allison K
Katzenstein, David
Ekstrom, Anna Mia
Ledwaba, Johanna
Mohapi, Lerato
Laher, Fatima
Petzold, Max
Morris, Lynn
Kantor, Rami
description BACKGROUND: Emergence of HIV-1 drug resistance is at times an inevitable and anticipated consequence of antiretroviral therapy (ART) failure. We examined drug resistance patterns and virus re-suppression among subtype C-infected South African patients receiving first-line ART. METHODS: Treatment records of 431 patients on NNRTI-containing regimens for a median of 45 months were analyzed. Patients with viral load (VL) >400 copies/mL were followed and drug resistance mutations (DRM) were re-assessed. Associations between clinical/demographic measures and drug resistance/virologic outcomes were examined using Fisher exact and ordinal and logistic regression. RESULTS: Ten percent of patients (43/431) were viremic at enrollment (98% previously suppressed); sequences were obtained from 38/43. Of those, 82% had 1-7 DRM. In bivariate analysis remote exposure to single-dose nevirapine or prior ART; higher CD4 counts; lower VL; and >6 months of virologic failure were significantly associated with number of DRM. Of 25 viremic patients followed for a median of 8 months on a continued first-line regimen, 12 (48%) re-suppressed, six with K103N and three with M184V. Thirteen (52%) had continued virologic failure which was significantly associated with detectable VL>6 months prior to enrollment and number of DRM. CONCLUSION: Among these HIV-1 subtype C-infected patients, DRM numbers and patterns were associated with prior exposure to sub-optimal ART, adherence and duration of virologic failure. Viral re-suppression in the presence of K103N and M184V challenges assumptions about drug resistance. In resource-limited settings, where genotyping and alternative drug options are unavailable, continuing first-line treatment, reinforcing adherence and regular virologic monitoring may be effective even after virologic failure.
doi_str_mv 10.4172/2155-6113.1000117
format article
fullrecord <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_541855</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>1835475760</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3527-1db987ca5bf5839ca54d4a79f85de696fb033b64a431b1aaf721494e63d9c1513</originalsourceid><addsrcrecordid>eNpVUktv3CAQtqpWTZTmB_RScezFiceAsS-Vou0jkSL10McVYTzepd0Fl8Fb5ff0jxZrN6vkxMd8jwHNFMVbqK4EqPq6BinLBoBfQVVVAOpFcX6qvXyCz4pLol9ZU_Gu7er6dXFWQ1crBc158e9jnNcsIjlKxltkk0kJoydm_MD2Ls6U2ZLmacoicsEzswt-zW7vfpbAaO7Tw4RsxZwf0SYclgCHPi02i27vstYHX_rZbjGQGzATe4yELEXjyUY3JZNvzm9c71KIlCH7Fua0YTdjdNa8KV6NZkt4eTwvih-fP31f3Zb3X7_crW7uS8tlrUoY-q5V1sh-lC3vMhCDMKobWzlg0zVjX3HeN8IIDj0YM6oaRCew4UNnQQK_KMpDLv3Fae71FN3OxAcdjNPH0u-MUEsBrZRZ_-Ggz8wOB5t_Hc32me05491Gr8Nec1Cireoc8P4YEMOfGSnpnSOL263xGGbS0HIplFRNlaVwkNoYiCKOpzZQ6WUf9DJvvcxbH_che949fd_J8Th9_h8rBbVz</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>1835475760</pqid></control><display><type>article</type><title>Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa</title><source>Freely Accessible Journals</source><creator>El-Khatib, Ziad ; Delong, Allison K ; Katzenstein, David ; Ekstrom, Anna Mia ; Ledwaba, Johanna ; Mohapi, Lerato ; Laher, Fatima ; Petzold, Max ; Morris, Lynn ; Kantor, Rami</creator><creatorcontrib>El-Khatib, Ziad ; Delong, Allison K ; Katzenstein, David ; Ekstrom, Anna Mia ; Ledwaba, Johanna ; Mohapi, Lerato ; Laher, Fatima ; Petzold, Max ; Morris, Lynn ; Kantor, Rami</creatorcontrib><description>BACKGROUND: Emergence of HIV-1 drug resistance is at times an inevitable and anticipated consequence of antiretroviral therapy (ART) failure. We examined drug resistance patterns and virus re-suppression among subtype C-infected South African patients receiving first-line ART. METHODS: Treatment records of 431 patients on NNRTI-containing regimens for a median of 45 months were analyzed. Patients with viral load (VL) &gt;400 copies/mL were followed and drug resistance mutations (DRM) were re-assessed. Associations between clinical/demographic measures and drug resistance/virologic outcomes were examined using Fisher exact and ordinal and logistic regression. RESULTS: Ten percent of patients (43/431) were viremic at enrollment (98% previously suppressed); sequences were obtained from 38/43. Of those, 82% had 1-7 DRM. In bivariate analysis remote exposure to single-dose nevirapine or prior ART; higher CD4 counts; lower VL; and &gt;6 months of virologic failure were significantly associated with number of DRM. Of 25 viremic patients followed for a median of 8 months on a continued first-line regimen, 12 (48%) re-suppressed, six with K103N and three with M184V. Thirteen (52%) had continued virologic failure which was significantly associated with detectable VL&gt;6 months prior to enrollment and number of DRM. CONCLUSION: Among these HIV-1 subtype C-infected patients, DRM numbers and patterns were associated with prior exposure to sub-optimal ART, adherence and duration of virologic failure. Viral re-suppression in the presence of K103N and M184V challenges assumptions about drug resistance. In resource-limited settings, where genotyping and alternative drug options are unavailable, continuing first-line treatment, reinforcing adherence and regular virologic monitoring may be effective even after virologic failure.</description><identifier>ISSN: 2155-6113</identifier><identifier>EISSN: 2155-6113</identifier><identifier>DOI: 10.4172/2155-6113.1000117</identifier><identifier>PMID: 21927716</identifier><language>eng</language><publisher>United States</publisher><ispartof>Journal of AIDS &amp; clinical research, 2011-02, Vol.2 (117)</ispartof><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3527-1db987ca5bf5839ca54d4a79f85de696fb033b64a431b1aaf721494e63d9c1513</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>230,314,776,780,881,27903,27904</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/21927716$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:221927716$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>El-Khatib, Ziad</creatorcontrib><creatorcontrib>Delong, Allison K</creatorcontrib><creatorcontrib>Katzenstein, David</creatorcontrib><creatorcontrib>Ekstrom, Anna Mia</creatorcontrib><creatorcontrib>Ledwaba, Johanna</creatorcontrib><creatorcontrib>Mohapi, Lerato</creatorcontrib><creatorcontrib>Laher, Fatima</creatorcontrib><creatorcontrib>Petzold, Max</creatorcontrib><creatorcontrib>Morris, Lynn</creatorcontrib><creatorcontrib>Kantor, Rami</creatorcontrib><title>Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa</title><title>Journal of AIDS &amp; clinical research</title><addtitle>J AIDS Clin Res</addtitle><description>BACKGROUND: Emergence of HIV-1 drug resistance is at times an inevitable and anticipated consequence of antiretroviral therapy (ART) failure. We examined drug resistance patterns and virus re-suppression among subtype C-infected South African patients receiving first-line ART. METHODS: Treatment records of 431 patients on NNRTI-containing regimens for a median of 45 months were analyzed. Patients with viral load (VL) &gt;400 copies/mL were followed and drug resistance mutations (DRM) were re-assessed. Associations between clinical/demographic measures and drug resistance/virologic outcomes were examined using Fisher exact and ordinal and logistic regression. RESULTS: Ten percent of patients (43/431) were viremic at enrollment (98% previously suppressed); sequences were obtained from 38/43. Of those, 82% had 1-7 DRM. In bivariate analysis remote exposure to single-dose nevirapine or prior ART; higher CD4 counts; lower VL; and &gt;6 months of virologic failure were significantly associated with number of DRM. Of 25 viremic patients followed for a median of 8 months on a continued first-line regimen, 12 (48%) re-suppressed, six with K103N and three with M184V. Thirteen (52%) had continued virologic failure which was significantly associated with detectable VL&gt;6 months prior to enrollment and number of DRM. CONCLUSION: Among these HIV-1 subtype C-infected patients, DRM numbers and patterns were associated with prior exposure to sub-optimal ART, adherence and duration of virologic failure. Viral re-suppression in the presence of K103N and M184V challenges assumptions about drug resistance. In resource-limited settings, where genotyping and alternative drug options are unavailable, continuing first-line treatment, reinforcing adherence and regular virologic monitoring may be effective even after virologic failure.</description><issn>2155-6113</issn><issn>2155-6113</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNpVUktv3CAQtqpWTZTmB_RScezFiceAsS-Vou0jkSL10McVYTzepd0Fl8Fb5ff0jxZrN6vkxMd8jwHNFMVbqK4EqPq6BinLBoBfQVVVAOpFcX6qvXyCz4pLol9ZU_Gu7er6dXFWQ1crBc158e9jnNcsIjlKxltkk0kJoydm_MD2Ls6U2ZLmacoicsEzswt-zW7vfpbAaO7Tw4RsxZwf0SYclgCHPi02i27vstYHX_rZbjGQGzATe4yELEXjyUY3JZNvzm9c71KIlCH7Fua0YTdjdNa8KV6NZkt4eTwvih-fP31f3Zb3X7_crW7uS8tlrUoY-q5V1sh-lC3vMhCDMKobWzlg0zVjX3HeN8IIDj0YM6oaRCew4UNnQQK_KMpDLv3Fae71FN3OxAcdjNPH0u-MUEsBrZRZ_-Ggz8wOB5t_Hc32me05491Gr8Nec1Cireoc8P4YEMOfGSnpnSOL263xGGbS0HIplFRNlaVwkNoYiCKOpzZQ6WUf9DJvvcxbH_che949fd_J8Th9_h8rBbVz</recordid><startdate>20110218</startdate><enddate>20110218</enddate><creator>El-Khatib, Ziad</creator><creator>Delong, Allison K</creator><creator>Katzenstein, David</creator><creator>Ekstrom, Anna Mia</creator><creator>Ledwaba, Johanna</creator><creator>Mohapi, Lerato</creator><creator>Laher, Fatima</creator><creator>Petzold, Max</creator><creator>Morris, Lynn</creator><creator>Kantor, Rami</creator><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope><scope>5PM</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D8T</scope><scope>ZZAVC</scope></search><sort><creationdate>20110218</creationdate><title>Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa</title><author>El-Khatib, Ziad ; Delong, Allison K ; Katzenstein, David ; Ekstrom, Anna Mia ; Ledwaba, Johanna ; Mohapi, Lerato ; Laher, Fatima ; Petzold, Max ; Morris, Lynn ; Kantor, Rami</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3527-1db987ca5bf5839ca54d4a79f85de696fb033b64a431b1aaf721494e63d9c1513</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><toplevel>online_resources</toplevel><creatorcontrib>El-Khatib, Ziad</creatorcontrib><creatorcontrib>Delong, Allison K</creatorcontrib><creatorcontrib>Katzenstein, David</creatorcontrib><creatorcontrib>Ekstrom, Anna Mia</creatorcontrib><creatorcontrib>Ledwaba, Johanna</creatorcontrib><creatorcontrib>Mohapi, Lerato</creatorcontrib><creatorcontrib>Laher, Fatima</creatorcontrib><creatorcontrib>Petzold, Max</creatorcontrib><creatorcontrib>Morris, Lynn</creatorcontrib><creatorcontrib>Kantor, Rami</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Freely available online</collection><collection>SwePub Articles full text</collection><jtitle>Journal of AIDS &amp; clinical research</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>El-Khatib, Ziad</au><au>Delong, Allison K</au><au>Katzenstein, David</au><au>Ekstrom, Anna Mia</au><au>Ledwaba, Johanna</au><au>Mohapi, Lerato</au><au>Laher, Fatima</au><au>Petzold, Max</au><au>Morris, Lynn</au><au>Kantor, Rami</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa</atitle><jtitle>Journal of AIDS &amp; clinical research</jtitle><addtitle>J AIDS Clin Res</addtitle><date>2011-02-18</date><risdate>2011</risdate><volume>2</volume><issue>117</issue><issn>2155-6113</issn><eissn>2155-6113</eissn><abstract>BACKGROUND: Emergence of HIV-1 drug resistance is at times an inevitable and anticipated consequence of antiretroviral therapy (ART) failure. We examined drug resistance patterns and virus re-suppression among subtype C-infected South African patients receiving first-line ART. METHODS: Treatment records of 431 patients on NNRTI-containing regimens for a median of 45 months were analyzed. Patients with viral load (VL) &gt;400 copies/mL were followed and drug resistance mutations (DRM) were re-assessed. Associations between clinical/demographic measures and drug resistance/virologic outcomes were examined using Fisher exact and ordinal and logistic regression. RESULTS: Ten percent of patients (43/431) were viremic at enrollment (98% previously suppressed); sequences were obtained from 38/43. Of those, 82% had 1-7 DRM. In bivariate analysis remote exposure to single-dose nevirapine or prior ART; higher CD4 counts; lower VL; and &gt;6 months of virologic failure were significantly associated with number of DRM. Of 25 viremic patients followed for a median of 8 months on a continued first-line regimen, 12 (48%) re-suppressed, six with K103N and three with M184V. Thirteen (52%) had continued virologic failure which was significantly associated with detectable VL&gt;6 months prior to enrollment and number of DRM. CONCLUSION: Among these HIV-1 subtype C-infected patients, DRM numbers and patterns were associated with prior exposure to sub-optimal ART, adherence and duration of virologic failure. Viral re-suppression in the presence of K103N and M184V challenges assumptions about drug resistance. In resource-limited settings, where genotyping and alternative drug options are unavailable, continuing first-line treatment, reinforcing adherence and regular virologic monitoring may be effective even after virologic failure.</abstract><cop>United States</cop><pmid>21927716</pmid><doi>10.4172/2155-6113.1000117</doi><oa>free_for_read</oa></addata></record>
fulltext fulltext
identifier ISSN: 2155-6113
ispartof Journal of AIDS & clinical research, 2011-02, Vol.2 (117)
issn 2155-6113
2155-6113
language eng
recordid cdi_swepub_primary_oai_swepub_ki_se_541855
source Freely Accessible Journals
title Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa
url http://sfxeu10.hosted.exlibrisgroup.com/loughborough?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-24T03%3A54%3A59IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-proquest_swepu&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Drug%20resistance%20patterns%20and%20virus%20re-suppression%20among%20HIV-1%20subtype%20C%20infected%20patients%20receiving%20non-nucleoside%20reverse%20transcriptase%20inhibitors%20in%20South%20Africa&rft.jtitle=Journal%20of%20AIDS%20&%20clinical%20research&rft.au=El-Khatib,%20Ziad&rft.date=2011-02-18&rft.volume=2&rft.issue=117&rft.issn=2155-6113&rft.eissn=2155-6113&rft_id=info:doi/10.4172/2155-6113.1000117&rft_dat=%3Cproquest_swepu%3E1835475760%3C/proquest_swepu%3E%3Cgrp_id%3Ecdi_FETCH-LOGICAL-c3527-1db987ca5bf5839ca54d4a79f85de696fb033b64a431b1aaf721494e63d9c1513%3C/grp_id%3E%3Coa%3E%3C/oa%3E%3Curl%3E%3C/url%3E&rft_id=info:oai/&rft_pqid=1835475760&rft_id=info:pmid/21927716&rfr_iscdi=true