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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...
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Published in: | Journal of AIDS & clinical research 2011-02, Vol.2 (117) |
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container_title | Journal of AIDS & clinical research |
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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 |
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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.</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 & 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 & 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) >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.</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 & 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 & 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) >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.</abstract><cop>United States</cop><pmid>21927716</pmid><doi>10.4172/2155-6113.1000117</doi><oa>free_for_read</oa></addata></record> |
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title | Drug resistance patterns and virus re-suppression among HIV-1 subtype C infected patients receiving non-nucleoside reverse transcriptase inhibitors in South Africa |
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