Time to Viremia for Patients Taking their First Antiretroviral Regimen and the Subsequent Resistance Profiles. Issue 1 (2nd January 2016)

• Record Type: Journal Article
• Authors: Crouzat, Frederic; Benoit, Anita C.; Kovacs, Colin; Smith, Graham; Taback, Nathan; Sandler, Ina; Acsai, Megan; Barrie, William; Brunetta, Jason; Chang, Benny; Fletcher, David; Knox, David; Merkley, Barry; Sharma, Malika; Tilley, David; Loutfy, Mona
• Is Part Of: HIV clinical trials. Volume 17:Issue 1(2016)
• Page Start: 1
• Page End: 11
• Publication Date: 2016-01-02
• Subjects: HIV -- first-line antiretroviral therapy -- viremia -- resistance mutations; HIV Infections -- Chemotherapy -- Periodicals; AIDS (Disease) -- Chemotherapy -- Periodicals; HIV Infections -- Research -- Periodicals; AIDS (Disease) -- Research -- Periodicals; 616.979206105
• DOI: 10.1080/15284336.2015.1111555
• Languages: English
• ISSNs: 1528-4336

Abstract

Abstract : Background: The resistance profiles for patients on first-line antiretroviral therapy (ART) regimens after viremia have not been well studied in community clinic settings in the modern treatment era. Objective: To determine time to viremia and the ART resistance profiles of viremic patients. Methods: HIV-positive patients aged ≥16 years initiating a three-drug regimen were retrospectively identified from 01/01/06 to 12/31/12. The regimens were a backbone of two nucleoside reverse transcriptase inhibitors (NRTIs) and a third agent: a protease inhibitor (PI), non-nucleoside reverse transcriptase inhibitor (NNRTI), or an integrase inhibitor (II). Time to viremia was compared using a proportional hazards model, adjusting for demographic and clinical factors. Resistance profiles were described in those with baseline and follow-up genotypes. Results: For 653 patients, distribution of third-agent use and viremia was: 244 (37%) on PIs with 80 viremia, 364 (56%) on NNRTIs with 84 viremia, and 45 (7%) on II with 11 viremia. Only for NNRTIs, time to viremia was longer than PIs ( p = 0.04) for patients with a CD4 count ≥200 cells/mm 3 . Of the 175 with viremia, 143 (82%) had baseline and 37 (21%) had follow-up genotype. Upon viremia, emerging ART resistance was rare. One new NNRTI (Y181C) mutation was identified and three patients taking PI-based regimens developed NRTI mutations (M184 V, M184I, and T215Y). Conclusions: Time to viremia for NNRTIs was longer than PIs. With viremia, ART resistance rarely developed without PI or II mutations, but with a few NRTI mutations in those taking PI-based regimens, and NNRTI mutations in those taking NNRTI-based regimens.