Preexisting resistance to nonnucleoside reverse-transcriptase inhibitors predicts virologic failure of an efavirenz-based regimen in treatment-naive HIV-1-infected subjects.
A case-cohort study was used to determine the effect of baseline nonnucleoside reverse-transcriptase inhibitor (NNRTI) resistance, as assessed by viral genotyping, on the response to efavirenz-containing regimens in AIDS Clinical Trials Group A5095. The sample included a random cohort of efavirenz-treated subjects plus unselected subjects who experienced virologic failure. Of 220 subjects in the random cohort, 57 (26%) had virologic failure. The prevalence of baseline NNRTI resistance was 5%. The risk of virologic failure for subjects with baseline NNRTI resistance was higher than that for subjects without such resistance (hazard ratio 2.27 [95% confidence interval], 1.15-4.49; P = .018). These results support resistance testing before starting antiretroviral therapy.
Kuritzkes
Daniel R
DR
Brigham and Women's Hospital, Harvard Medical School, Cambridge, MA 02139, USA. dkuritzkes@partners.org
Lalama
Christina M
CM
Ribaudo
Heather J
HJ
Marcial
Michelle
M
Meyer
William A
WA
Shikuma
Cecilia
C
Johnson
Victoria A
VA
Fiscus
Susan A
SA
D'Aquila
Richard T
RT
Schackman
Bruce R
BR
Acosta
Edward P
EP
Gulick
Roy M
RM
D000328:Adult; D000480:Alkynes; D048588:Benzoxazines / Q000008:administration & dosage*; D016022:Case-Control Studies; D015331:Cohort Studies; D003521:Cyclopropanes; D004334:Drug Administration Schedule; D024921:Drug Resistance, Multiple, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors*; D015497:HIV-1 / Q000201:enzymology / Q000254:growth & development*; D006801:Humans; D008297:Male; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage*; D017211:Treatment Failure
D000480:Alkynes; D048588:Benzoxazines; D003521:Cyclopropanes; D018894:Reverse Transcriptase Inhibitors; C514824:reverse transcriptase, Human immunodeficiency virus 1; D054303:HIV Reverse Transcriptase; C098320:efavirenz