title: Multi-nucleoside reverse transcriptase inhibitor resistant HIV type-1 in a patient from Sierra Leone failing stavudine, lamivudine and nevirapine.
abstract: We report a 33-year-old HIV type-1 (HIV-1)-infected male from Sierra Leone who harboured extensive drug resistance mutations to all nucleoside reverse transcriptase inhibitors (NRTIs) and non-NRTIs, including the multi-NRTI-resistance Q151M complex, K65R, M184I and Y181I, after using standard first-line generic fixed-dose stavudine, lamivudine and nevirapine (Triomune™) for 36 months. In the context of non-B subtypes in resource-limited countries, first-line stavudine-containing regimens have been associated with more extensive and complex mutation patterns, compared with subtype B viruses. Whether the extensive and complex NRTI resistance patterns found among African patients failing first-line antiretroviral therapy is explained by viral genetic diversity or by different patient monitoring strategies remains to be elucidated. Emerging multi-NRTI resistance in sub-Saharan Africa would not only compromise second-line treatment options and the success of antiretroviral rollout, but could also contribute to the spread of drug-resistant variants worldwide.
authors.affiliation: Department of Internal Medicine, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands. r.hamers@pharmaccess.org
authors.forename: Raph L
authors.initials: RL
authors.lastname: Hamers
authors.forename: Annemarie Mj
authors.initials: AM
authors.lastname: Wensing
authors.forename: Nicole Kt
authors.initials: NK
authors.lastname: Back
authors.forename: Maria S
authors.initials: MS
authors.lastname: Arcilla
authors.forename: Jos Ph
authors.initials: JP
authors.lastname: Frissen
mesh_terms: D000328:Adult; D024921:Drug Resistance, Multiple, Viral / Q000187:drug effects* / Q000235:genetics*; D014644:Genetic Variation; D015658:HIV Infections / Q000188:drug therapy* / Q000235:genetics* / Q000821:virology; D054303:HIV Reverse Transcriptase / Q000037:antagonists & inhibitors / Q000235:genetics; D015497:HIV-1 / Q000187:drug effects / Q000235:genetics; D006801:Humans; D019259:Lamivudine / Q000008:administration & dosage / Q000627:therapeutic use; D008297:Male; D008991:Monitoring, Physiologic; D009154:Mutation; D019829:Nevirapine / Q000008:administration & dosage / Q000627:therapeutic use; D009705:Nucleosides / Q000378:metabolism; D018894:Reverse Transcriptase Inhibitors / Q000008:administration & dosage* / Q000627:therapeutic use; D012807:Sierra Leone; D018119:Stavudine / Q000008:administration & dosage / Q000627:therapeutic use; D017211:Treatment Failure
chemical_list: D009705:Nucleosides; D018894:Reverse Transcriptase Inhibitors; D019259:Lamivudine; D019829:Nevirapine; D018119:Stavudine; D054303:HIV Reverse Transcriptase