title: Occurrence of etravirine/rilpivirine-specific resistance mutations selected by efavirenz and nevirapine in Kenyan patients with non-B HIV-1 subtypes failing antiretroviral therapy.
abstract: Resistance to efavirenz and nevirapine has not been associated with mutations at position 138 of reverse transcriptase. In an evaluation of virologic suppression rates in PEPFAR (President's Emergency Plan For AIDS Relief) clinics in Kenya among patients on first-line therapy (RV288), 63% (617/975) of randomly selected patients on antiretroviral therapy were suppressed (HIV RNA<400 copies/ml). Among those with non-nucleoside reverse transcriptase inhibitor resistance (n = 101), 14 (13.8%) had substitutions at 138 (A, G, K or Q), mutations selected only by etravirine and rilpivirine in subtype B viruses. All 14 patients received efavirenz or nevirapine, not etravirine or rilpivirine, and were predominantly subtype A1. This may be the first report of efavirenz and nevirapine selecting these mutations in these subtypes.
authors.affiliation: aU.S. Military HIV Research Program, Global Health Programs, Walter Reed Army Institute of Research, Silver Spring bHenry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland, USA cKenya Defense Forces (KDF), United States Army Medical Research Unit - Kenya (USAMRU-K), Nairobi, Kenya dKenya Medical Research Institute (KEMRI)/Walter Reed Program, South Rift Valley (SRV), US Army Medical Research Unit-Kenya (USAMRU-K), Kerich, Kenya eSouthern Highlands Walter Reed Program, Mbeya, Tanzania.
authors.forename: Keith W
authors.initials: KW
authors.lastname: Crawford
authors.forename: Dorothy
authors.initials: D
authors.lastname: Njeru
authors.forename: Jonah
authors.initials: J
authors.lastname: Maswai
authors.forename: Milton
authors.initials: M
authors.lastname: Omondi
authors.forename: Duncan
authors.initials: D
authors.lastname: Apollo
authors.forename: Jane
authors.initials: J
authors.lastname: Kimetto
authors.forename: Lawrence
authors.initials: L
authors.lastname: Gitonga
authors.forename: James
authors.initials: J
authors.lastname: Munyao
authors.forename: Raphael
authors.initials: R
authors.lastname: Langat
authors.forename: Appolonia
authors.initials: A
authors.lastname: Aoko
authors.forename: Jemutai
authors.initials: J
authors.lastname: Tarus
authors.forename: Samoel
authors.initials: S
authors.lastname: Khamadi
authors.forename: Tiffany E
authors.initials: TE
authors.lastname: Hamm
mesh_terms: D019380:Anti-HIV Agents / Q000494:pharmacology*; D003430:Cross-Sectional Studies; D024882:Drug Resistance, Viral; D015658:HIV Infections / Q000188:drug therapy / Q000821:virology*; D015497:HIV-1 / Q000187:drug effects* / Q000235:genetics* / Q000302:isolation & purification; D006801:Humans; D007630:Kenya; D008969:Molecular Sequence Data; D020125:Mutation, Missense; D012641:Selection, Genetic; D017422:Sequence Analysis, DNA; D017211:Treatment Failure
chemical_list: D019380:Anti-HIV Agents