title: Genotypic resistance at viral rebound among patients who received lopinavir/ritonavir-based or efavirenz-based first antiretroviral therapy in South Africa.
abstract: Nonnucleoside reverse transcriptase inhibitor-drug resistance mutations (DRM) are increasingly reported in Africans failing their first antiretroviral regimen. The Phidisa II trial randomized treatment-naive participants to lopinavir/ritonavir or efavirenz with stavudine + lamivudine or zidovudine + didanosine. We report the prevalence of DRM in subjects who achieved HIV RNA <400 copies per milliliter at 6 months, but subsequently had 2 consecutive HIV RNA >1000 copies per milliliter. Sixty-eight participants fulfilled the inclusion criteria. nonnucleoside reverse transcriptase inhibitor-DRM were found in 17 of 36 (47.2%) efavirenz recipients, and M184V/I mutation in 14 of 40 (35.0%) lamivudine recipients. No protease inhibitor mutation was identified in 38 lopinavir/ritonavir recipients. This is one of the first studies in Africa confirming the paucity of protease inhibitor-associated DRM despite virologic failure.
authors.affiliation: Office of Clinical Operation, Project Phidisa, South African Military Health Service (SAMHS), Pretoria, South Africa.
authors.forename: J Nomthandazo
authors.initials: JN
authors.lastname: Dlamini
authors.forename: Zonghui
authors.initials: Z
authors.lastname: Hu
authors.forename: Johanna
authors.initials: J
authors.lastname: Ledwaba
authors.forename: Lynn
authors.initials: L
authors.lastname: Morris
authors.forename: Frank M
authors.initials: FM
authors.lastname: Maldarelli
authors.forename: Robin L
authors.initials: RL
authors.lastname: Dewar
authors.forename: Helene C
authors.initials: HC
authors.lastname: Highbarger
authors.forename: Harsha
authors.initials: H
authors.lastname: Somaroo
authors.forename: Phumelele
authors.initials: P
authors.lastname: Sangweni
authors.forename: Dean A
authors.initials: DA
authors.lastname: Follmann
authors.forename: Alice K
authors.initials: AK
authors.lastname: Pau
mesh_terms: D000328:Adult; D000480:Alkynes; D019380:Anti-HIV Agents / Q000008:administration & dosage* / Q000494:pharmacology; D023241:Antiretroviral Therapy, Highly Active / Q000379:methods*; D048588:Benzoxazines / Q000008:administration & dosage* / Q000494:pharmacology; D003521:Cyclopropanes; D024882:Drug Resistance, Viral; D005260:Female; D015658:HIV Infections / Q000188:drug therapy* / Q000821:virology; D006801:Humans; D061466:Lopinavir / Q000008:administration & dosage* / Q000494:pharmacology; D008297:Male; D009154:Mutation; D012367:RNA, Viral / Q000097:blood / Q000235:genetics; D019438:Ritonavir / Q000008:administration & dosage* / Q000494:pharmacology; D013019:South Africa; D017211:Treatment Failure; D019562:Viral Load
chemical_list: D000480:Alkynes; D019380:Anti-HIV Agents; D048588:Benzoxazines; D003521:Cyclopropanes; D012367:RNA, Viral; D061466:Lopinavir; C098320:efavirenz; D019438:Ritonavir