title: The role of toxicity-related regimen changes in the development of antiretroviral resistance.
abstract: In an effort to evaluate factors associated with the development of antiretroviral (ARV) resistance, we assessed the prevalence of toxicity-related regimen changes and modeled its association to the subsequent development of ARV resistance in a cohort of treatment-naive individuals initiating ARV therapy (ART). A retrospective analysis of patients initiating ART was conducted at the UAB 1917 Clinic from 1 January 2000 to 30 September 2007. Cox proportional hazards models were fit to identify factors associated with the development of resistance to ≥1 ARV drug class. Among 462 eligible participants, 14% (n=64) developed ARV resistance. Individuals with ≥1 toxicity-related regimen change (HR=3.94, 95% CI=1.09-14.21), initiating ART containing ddI or d4T (4.12, 1.19-14.26), and from a minority race (2.91, 1.16-7.28) had increased risk of developing resistance. Achieving virologic suppression within 12 months of ART initiation (0.10, 0.05-0.20) and higher pretreatment CD4 count (0.85 per 50 cells/mm(3), 0.75-0.96) were associated with decreased hazards of resistance. Changes in ART due to drug intolerance were associated with the subsequent development of ARV resistance. Understanding the role of ARV drug selection and other factors associated with the emergence of ARV resistance will help inform interventions to improve patient care and ensure long-term treatment success.
authors.affiliation: Department of Medicine, Division of Infectious Diseases, University of Alabama at Birmingham, USA. crnevin@uab.edu
authors.forename: Christa R
authors.initials: CR
authors.lastname: Nevin
authors.forename: Jiatao
authors.initials: J
authors.lastname: Ye
authors.forename: Inmaculada
authors.initials: I
authors.lastname: Aban
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mugavero
authors.forename: David
authors.initials: D
authors.lastname: Jackson
authors.forename: Hui-Yi
authors.initials: HY
authors.lastname: Lin
authors.forename: Jeroan
authors.initials: J
authors.lastname: Allison
authors.forename: James L
authors.initials: JL
authors.lastname: Raper
authors.forename: Michael S
authors.initials: MS
authors.lastname: Saag
authors.forename: James H
authors.initials: JH
authors.lastname: Willig
mesh_terms: D000328:Adult; D019380:Anti-HIV Agents / Q000008:administration & dosage / Q000009:adverse effects*; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D028761:Withholding Treatment
chemical_list: D019380:Anti-HIV Agents