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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Antiretroviral resistance patterns and factors associated with resistance in adult patients failing NNRTI-based regimens in the western cape, South Africa
Journal of Medical Virology, Volume 83, No. 10, Year 2011
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Description
Antiretroviral drug resistance in patients failing non-nucleoside reverse transcriptase inhibitor (NNRTI)-based first-line combination antiretroviral treatment (ART) is influenced by: regimen choice, HIV-1 subtype, detection of and response to therapy failure. In order to describe resistance patterns by genotypic testing, at the time of first-line ART failure and to describe associations with having M184I/V, K65R, three or more thymidine analog mutations (TAMs) and etravirine (ETV) resistance, the prevalence of antiretroviral drug resistance associated mutations in a cross-sectional study, at two South African public health clinic settings, at the time of virologic failure (HIV-1 RNA load >400copies/ml) are described. Also reported are associations of therapy choice, prolonged virologic failure, and concurrent HIV viral load and CD4 count with the presence of M184I/V, TAMs, K65R, and resistance to ETV. Of 167 adult patients with virologic failure on first-line ART, 28 (17%) had no resistance, 137 (82%) had NNRTI resistance, 101 (60%) M184I/V, 20 (12%) TAMs, of which 4 had 3 or more TAMs, and 7 (4%) had K65R, of which 6 were on D4T and one on AZT. A prolonged estimated period of failure was associated with having ≥3 TAMs. Patients treated with nevirapine (NVP) were more likely to have ETV resistance than those treated with efavirenz (EFV). Major protease inhibitor mutations were not detected. A delayed response to ART failure may risk accumulation of TAMs in patients on an NNRTI-based regimen. The use of NVP rather than EFV was associated with ETV resistance. © 2011 Wiley-Liss, Inc..
Authors & Co-Authors
Van Zyl, Gert Uves
South Africa, Stellenbosch
Stellenbosch University
South Africa, Johannesburg
National Health Laboratory Service
van der Merwe, Lize
South Africa, Tygerberg
South African Medical Research Council
South Africa, Bellville
University of the Western Cape
Claassen, Mathilda
South Africa, Stellenbosch
Stellenbosch University
South Africa, Johannesburg
National Health Laboratory Service
Zeier, Michèle Desiré
South Africa, Stellenbosch
Stellenbosch University
South Africa, Tygerberg
Tygerberg Hospital
Preiser, Wolfgang
South Africa, Stellenbosch
Stellenbosch University
South Africa, Johannesburg
National Health Laboratory Service
Statistics
Citations: 49
Authors: 5
Affiliations: 5
Identifiers
Doi:
10.1002/jmv.22189
ISSN:
01466615
e-ISSN:
10969071
Research Areas
Health System And Policy
Infectious Diseases
Study Design
Cross Sectional Study
Study Approach
Quantitative
Study Locations
South Africa