Impact of transmitted drug-resistance on treatment selection and outcome of first-line Highly Active Antiretroviral Therapy (HAART)

TitleImpact of transmitted drug-resistance on treatment selection and outcome of first-line Highly Active Antiretroviral Therapy (HAART)
Publication TypeJournal Article
Year of Publication2010
AuthorsBansi L, Geretti AM, Dunn DT, Hill T, Green H, Fearnhill E, Gazzard B, Nelson M, Porter K, Phillips AN, Sabin CA
JournalJ Acquir Immune Defic Syndr
Volume53
Pagination633-9
Date PublishedApr
ISBN Number1525-4135
Accession Number21080527
Keywords*Antiretroviral Therapy, Highly Active, *Genotype, Adult, Cohort Studies, Drug Resistance, Viral/*genetics, Female, HIV Infections/*drug therapy/*virology, Humans, Male, Prevalence, Recurrence, Treatment Outcome, Viral Load
Abstract

OBJECTIVE: The study aim was to determine how resistance testing influences outcome of first-line highly active antiretroviral therapy (HAART) in routine practice in the United Kingdom. METHODS: The prevalence of transmitted drug resistance and the genotypic sensitivity score (GSS) of first-line HAART regimens were determined using data from the UK Collaborative HIV Cohort(CHIC) Study. Factors associated with starting a regimen with a reduced GSS and subsequent virological responses were analyzed by logistic and Cox regression. RESULTS: Amongst patients tested in 1999-2006, 116 of 1175 (10%) had $1 resistance mutation; 64 patients (5.4%) had $1 mutation associated with resistance to drugs in the initial HAART regimen and 54 (4.6%) showed a GSS, 3. Factors independently associated with a GSS, 3 were starting HAART in 1999-2001 vs. 2004-2006 (odds ratio = 2.63; 95% confidence interval: 1.19 to 5.83) and use of ritonavir-boosted protease inhibitor (PI/r)-based vs. nonnucleoside reverse transcriptase inhibitor-based regimens (1.97; 1.06 to 3.64). AGSS .3 was independently associated with virological suppression(hazard ratio for GSS, 3 = 0.60; 95% confidence interval 0.41 to 0.87). CONCLUSIONS: Most patients starting HAART after undergoing resistance testing received regimens with a GSS $3. PI/r-based therapy was often selected in patients with resistance to the nucleoside reverse transcriptase inhibitor backbone. Low GSS predicted poor virological suppression and the association persisted after adjusting for PI/r use.

Short TitleJournal of acquired immune deficiency syndromes (1999)
Alternate JournalJournal of acquired immune deficiency syndromes (1999)