title: Comparative analysis of HIV type 1 genotypic resistance across antiretroviral trial treatment regimens.
abstract: From data on HIV-1 genotypes collected from antiretroviral trial participants who fail virologically, we describe methods for comparing distributions of acquired HIV-1 mutations across different treatment regimens. Given a definition of a "mutational distance" that summarizes the genetic change of a subject's virus in a way that captures the resistance cost of exposure to an antiretroviral regimen, these comparative analyses inform about the relative treatability of emergent virus by next-line therapy directed to the same viral target. The utility of the methods is illustrated by application to data from AIDS Clinical Trials Group (ACTG) Study 241. We find that patients failing zidovudine/didanosine/nevirapine accumulated a 2.41-fold greater nonnucleoside reverse transcriptase inhibitor (RTI) mutational distance than patients failing zidovudine/didanosine [95% confidence interval (1.55, 5.26), p < 0.000001], quantitating expectations that adding a nonnucleoside RTI to a double nucleoside regimen may attenuate future effectiveness of nonnucleoside RTI therapy for nucleoside-experienced patients if viremia is not suppressed. We also find that persons with extensive prior experience with suboptimal nucleoside therapy who were virologically failing zidovudine/didanosine/nevirapine or zidovudine/didanosine accumulated a similar nucleoside RTI mutational distance, implying that the addition of the nonnucleoside RTI did not preserve future nucleoside options.
authors.affiliation: Center for Biostatistics in AIDS Research and Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts 02115, USA. pgilbert@hsph.harvard.edu
authors.forename: P B
authors.initials: PB
authors.lastname: Gilbert
authors.forename: G J
authors.initials: GJ
authors.lastname: Hanna
authors.forename: V
authors.initials: V
authors.lastname: De Gruttola
authors.forename: J
authors.initials: J
authors.lastname: Martinez-Picado
authors.forename: D R
authors.initials: DR
authors.lastname: Kuritzkes
authors.forename: V A
authors.initials: VA
authors.lastname: Johnson
authors.forename: D D
authors.initials: DD
authors.lastname: Richman
authors.forename: R T
authors.initials: RT
authors.lastname: D'Aquila
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology* / Q000627:therapeutic use; D019295:Computational Biology / Q000379:methods*; D004252:DNA Mutational Analysis / Q000379:methods*; D004352:Drug Resistance, Microbial / Q000235:genetics*; D004359:Drug Therapy, Combination; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology* / Q000627:therapeutic use
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors