Primary HIV drug resistance and efficacy of first-line antiretroviral therapy guided by resistance testing.
BACKGROUND
Primary HIV drug resistance has been associated with poor treatment outcome of first-line highly active antiretroviral therapy (HAART) in several trials. The aim of the study was to assess the efficacy of first-line HAART guided by resistance testing.


METHODS
In a prospective multicenter study in the state of Nordrhein-Westfalen, Germany, chronically HIV-infected patients underwent genotypic resistance testing and were monitored for 48 weeks after initiation of HAART.


RESULTS
Primary drug resistance was found in 30 of 269 patients entering the study between January 2001 and December 2003 [11.2%; 95% confidence interval, 7.4-14.9]. In intent-to-treat analysis, the proportion of patients with viral load below 50 copies/mL after 24 and 48 weeks was 70.0% and 66.7%, respectively, in patients with resistance and 74.1% and 73.6%, respectively, in patients without (P = 0.66 and 0.51). In on-treatment analysis, the proportions were 80.8% and 83.3%, respectively, in patients with resistance and 81.9% and 85.0%, respectively, in patients without (P= 0.79 and 0.77). These results were also valid considering a detection limit of 400 copies/mL.


CONCLUSIONS
The prevalence of primary drug resistance was 11.2% in chronically HIV-infected patients. HAART guided by resistance testing had similar efficacy in patients with primary drug resistance as compared with patients with wild-type virus. Based on these facts, resistance-adapted first-line HAART is suggested as routine practice.
Oette
Mark
M
Clinic for Gastroenterology, Hepatology, and Infectious Diseases, University Clinic Düsseldorf, Moorenstrasse 5, 40225 Düsseldorf, Germany. oettem@med.uni-duesseldorf.de
Kaiser
Rolf
R
Däumer
Martin
M
Petch
Ruth
R
Fätkenheuer
Gerd
G
Carls
Horst
H
Rockstroh
Jürgen Kurt
JK
Schmalöer
Dirk
D
Stechel
Jürgen
J
Feldt
Torsten
T
Pfister
Herbert
H
Häussinger
Dieter
D
D000328:Adult; D019380:Anti-HIV Agents / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D018791:CD4 Lymphocyte Count; D024882:Drug Resistance, Viral; D005006:Ethnicity; D005260:Female; D005858:Germany / Q000453:epidemiology; D015658:HIV Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000635:transmission; D006801:Humans; D008297:Male; D008875:Middle Aged
D019380:Anti-HIV Agents