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Triple-class antiretroviral drug resistance: risk and predictors among HIV-1-infected patients.
AIDS. 2007 Apr 23; 21(7):825-34.AIDS

Abstract

BACKGROUND

HIV-1 triple-class antiretroviral drug resistance (TC-DR) may substantially limit therapeutic options and compromise clinical outcomes.

OBJECTIVE

To estimate TC-DR prevalence and incidence, and identify risk factors for TC-DR acquisition.

METHODS

We identified patients in the University of North Carolina HIV Cohort Study with TC-DR HIV-1 variants. Nucleos(t)ide reverse transcriptase inhibitor (NRTI), non-nucleoside reverse transcriptase inhibitor (NNRTI), and major protease inhibitor (PI) mutations, were based on the International AIDS Society - USA guidelines. Prevalence was estimated with the exact binomial distribution, incidence with the exact Poisson distribution, and multivariable analyses were performed using logistic regression.

RESULTS

Of 1587 patients, half initiated therapy with HAART (N = 789), 20% (N = 320) with non-HAART combination therapy, and 30% (N = 478) with one NRTI. The median time on therapy was 5.7 years [interquartile range (IQR) 2.9, 8.6], the median number of previous antiretroviral agents was six (IQR 4, 8), and 47% (N = 752) were exposed to at least one NRTI, NNRTI and PI. Assuming patients without genotypes did not harbor TC-DR virus, the prevalence of TC-DR among all antiretroviral-experienced patients was 8% [95% confidence interval (CI) 6%, 9%]. The prevalence was 3% (95% CI 2%, 4%) and 12% (95% CI 10%, 15%) among patients treated initially with HAART and non-HAART, respectively. The number of antiretroviral agents received and initiating therapy with non-HAART or an unboosted PI, increased TC-DR risk in multivariable analyses.

CONCLUSION

The majority of patients with TC-DR have extensive antiretroviral exposure, particularly to non-HAART regimens, whereas HAART initiators are at low risk of acquiring TC-DR during a median of 4 years of follow-up.

Authors+Show Affiliations

Division of Infectious Diseases, School of Medicine, the University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA. napravs@med.unc.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

17415037

Citation

Napravnik, Sonia, et al. "Triple-class Antiretroviral Drug Resistance: Risk and Predictors Among HIV-1-infected Patients." AIDS (London, England), vol. 21, no. 7, 2007, pp. 825-34.
Napravnik S, Keys JR, Quinlivan EB, et al. Triple-class antiretroviral drug resistance: risk and predictors among HIV-1-infected patients. AIDS. 2007;21(7):825-34.
Napravnik, S., Keys, J. R., Quinlivan, E. B., Wohl, D. A., Mikeal, O. V., & Eron, J. J. (2007). Triple-class antiretroviral drug resistance: risk and predictors among HIV-1-infected patients. AIDS (London, England), 21(7), 825-34.
Napravnik S, et al. Triple-class Antiretroviral Drug Resistance: Risk and Predictors Among HIV-1-infected Patients. AIDS. 2007 Apr 23;21(7):825-34. PubMed PMID: 17415037.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Triple-class antiretroviral drug resistance: risk and predictors among HIV-1-infected patients. AU - Napravnik,Sonia, AU - Keys,Jessica R, AU - Quinlivan,E Byrd, AU - Wohl,David A, AU - Mikeal,Oksana V, AU - Eron,Joseph J,Jr PY - 2007/4/7/pubmed PY - 2007/11/6/medline PY - 2007/4/7/entrez SP - 825 EP - 34 JF - AIDS (London, England) JO - AIDS VL - 21 IS - 7 N2 - BACKGROUND: HIV-1 triple-class antiretroviral drug resistance (TC-DR) may substantially limit therapeutic options and compromise clinical outcomes. OBJECTIVE: To estimate TC-DR prevalence and incidence, and identify risk factors for TC-DR acquisition. METHODS: We identified patients in the University of North Carolina HIV Cohort Study with TC-DR HIV-1 variants. Nucleos(t)ide reverse transcriptase inhibitor (NRTI), non-nucleoside reverse transcriptase inhibitor (NNRTI), and major protease inhibitor (PI) mutations, were based on the International AIDS Society - USA guidelines. Prevalence was estimated with the exact binomial distribution, incidence with the exact Poisson distribution, and multivariable analyses were performed using logistic regression. RESULTS: Of 1587 patients, half initiated therapy with HAART (N = 789), 20% (N = 320) with non-HAART combination therapy, and 30% (N = 478) with one NRTI. The median time on therapy was 5.7 years [interquartile range (IQR) 2.9, 8.6], the median number of previous antiretroviral agents was six (IQR 4, 8), and 47% (N = 752) were exposed to at least one NRTI, NNRTI and PI. Assuming patients without genotypes did not harbor TC-DR virus, the prevalence of TC-DR among all antiretroviral-experienced patients was 8% [95% confidence interval (CI) 6%, 9%]. The prevalence was 3% (95% CI 2%, 4%) and 12% (95% CI 10%, 15%) among patients treated initially with HAART and non-HAART, respectively. The number of antiretroviral agents received and initiating therapy with non-HAART or an unboosted PI, increased TC-DR risk in multivariable analyses. CONCLUSION: The majority of patients with TC-DR have extensive antiretroviral exposure, particularly to non-HAART regimens, whereas HAART initiators are at low risk of acquiring TC-DR during a median of 4 years of follow-up. SN - 0269-9370 UR - https://www.unboundmedicine.com/medline/citation/17415037/Triple_class_antiretroviral_drug_resistance:_risk_and_predictors_among_HIV_1_infected_patients_ L2 - https://doi.org/10.1097/QAD.0b013e32805e8764 DB - PRIME DP - Unbound Medicine ER -