title: Rapid accumulation of nonnucleoside reverse transcriptase inhibitor-associated resistance: evidence of transmitted resistance in rural South Africa.
abstract: In a large cohort in rural South Africa, 73% of subtype-C-infected patients initiating highly active antiretroviral therapy achieved viral suppression. In patients with subsequent virological failure, an unexpected, rapid accumulation of nonnucleoside reverse transcriptase inhibitor-associated mutations was observed, whereas no thymidine analogue-associated mutations emerged. It appeared that several patients had drug-associated mutations prior to starting antiretrovirals, suggesting that transmission of resistance may have contributed to the accumulation of nonnucleoside reverse transcriptase inhibitor-mutations. Importantly, monitoring of HIV-RNA and prompt switch of treatment may prevent development of thymidine analogue-associated mutations.
authors.affiliation: Department of Internal Medicine and Infectious Diseases, University Medical Centre Utrecht, Utrecht, The Netherlands. r.e.barth@umcutrecht.nl
authors.forename: Roos E
authors.initials: RE
authors.lastname: Barth
authors.forename: Annemarie M
authors.initials: AM
authors.lastname: Wensing
authors.forename: Hugo A
authors.initials: HA
authors.lastname: Tempelman
authors.forename: Robert
authors.initials: R
authors.lastname: Moraba
authors.forename: Rob
authors.initials: R
authors.lastname: Schuurman
authors.forename: Andy I
authors.initials: AI
authors.lastname: Hoepelman
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology / Q000627:therapeutic use*; D023241:Antiretroviral Therapy, Highly Active; D024882:Drug Resistance, Viral / Q000235:genetics; D015658:HIV Infections / Q000188:drug therapy* / Q000635:transmission / Q000821:virology; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008137:Longitudinal Studies; D009154:Mutation; D018894:Reverse Transcriptase Inhibitors / Q000494:pharmacology / Q000627:therapeutic use*; D012423:Rural Health / Q000706:statistics & numerical data; D013019:South Africa
chemical_list: D019380:Anti-HIV Agents; D018894:Reverse Transcriptase Inhibitors