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Comparison of genotypic resistance profiles and virological response between patients starting nevirapine and efavirenz in EuroSIDA

2008; Lippincott Williams & Wilkins; Volume: 22; Issue: 3 Linguagem: Inglês

10.1097/qad.0b013e3282f3cc35

1473-5571

Wendy Bannister, Lı́dia Ruiz, Alessandro Cozzi‐Lepri, Amanda Mocroft, Ole Kirk, Schlomo Staszewski, Clive Loveday, Anders Karlsson, Antonella d’Arminio Monforte, Bonaventura Clotet, Jens Lundgren, Marcelo Losso, Adriana Durán, N. Vetter, Igor Karpov, Anna Vassilenko, N. Clumeck, Suzanne Dewit, Bénédicte Poll, Robert Colebunders, Kosta Kostov, J. Begovac, Matti Ristola, Ladislav Machala, H Rozsypal, Dalibor Sedláček, Jens Nielsen, Jens Lundgren, Thomas Benfield, O. Kirk, Jan Gerstoft, Terese L. Katzenstein, Ann‐Brit Eg Hansen, Peter Skinhøj, Court Pedersen, Lars Oestergaard, Kai Zilmer, Jelena Šmidt, C. Katlama, Viard Jp, Pierre Marie Girard, J.‐M. Livrozet, Philippe Vanhems, Christian Pradier, François Dabis, Jürgen K. Rockstroh, Robert L. Schmidt, Jan van Lunzen, Olaf Degen, Hans‐Jürgen Stellbrink, Schlomo Staszewski, J. R. Bogner, Gerd Fätkenheuer, J. Kosmidis, Panagiotis Gargalianos, G. Xylomenos, J. Perdios, G. Panos, A. Filandras, E. Karabatsaki, H. Sambattakou, Dénes Bánhegyi, F Mulcahy, Israel Yust, Dianna Turner, Melissa L. Burke, Simcha Pollack, Gamal Hassoun, S Maayan, Antonio Chiesi, Roberto Esposito, I. Mazeu, Cristina Mussini, Cumhur Arıcı, R. Pristerà, F. Mazzotta, Andrea Gabbuti, Vincenzo Vullo, Miriam Lichtner, Antonio Chirianni, E. Montesarchio, Marcela Gargiulo, Giovanni Antonucci, Fabio Iacomi, Philipp Narciso, Chrysoula Vlassi, Maria Carla Re, Adriano Lazzarin, Renato Finazzi, Massimo Galli, Anna Lisa Ridolfo, Antonella d’Arminio Monforte, Baiba Rozentāle, Pauls Aldiņš, Saulius Chaplinskas, R Hemmer, T. Staub, Peter Reiß, Jens Meldgaard Bruun, A Mæland, Vidar Ormaasen, Brygida Knysz, Jacek Gąsiorowski, A Horban, D Prokopowicz, Alicja Wiercińska‐Drapało, A. Boron-Kaczmarska, M. Pynka, Marek Beniowski, E. Mularska, H Trocha, Francisco Antunes, Emília Valadas, K. Mansinho, Fernando Maltêz, Dan Duiculescu, Aza Rakhmanova, Ekaterina Vinogradova, S. A. Buzunova, Djordje Jevtović, M Mokrás, D Staneková, J. González-Lahoz, Vincent Soriano, Luz Martín‐Carbonero, Pablo Labarga, Bonaventura Clotet, A. Jou, J. Alberto Conejero, C. Tural, José M. Gatell, José M. Miró, Pere Domingo, M. Gutierrez, Gràcia Mateo, M. A. Sambeat, Annika C. Karlsson, Paula Persson, Leo Flamholc, Bruno Ledergerber, Rainer Weber, P Francioli, Marie Paule Schneider, B Hirschel, E. Boffi, H Furrer, M Battegay, Luigia Elzi, Елена Николаевна Кравченко, N. Chentsova, Samantha Barton, Margaret Johnson, D Mercey, Andrew Phillips, Margaret Johnson, Amanda Mocroft, M. Murphy, Jonathan Weber, G Scullard, M Fisher, Ray P. Brettle, José M. Gatell, Brian Gazzard, Antonella D’Arminio Montforte, Nina Friis‐Møller, Alessandro Cozzi‐Lepri, Wendy Bannister, M. Ellefson, Annie Borch, D. Podlevkareva, Cara Olsen, J. Kjar, L.J. Peters, Joanne Reekie,

Pneumocystis jirovecii pneumonia detection and treatment

To compare virological outcome and genotypic resistance profiles in HIV-1-infected patients starting non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimens.NNRTI-naive patients were included who started treatment with nevirapine (NVP) or efavirenz (EFV) with genotypic resistance test results available at time of initiation (baseline). Virological failure was defined as two consecutive values > 500 copies/ml after starting the regimen. Cox models were used to investigate time to virological failure (the first of two values).A total of 759 patients were included (13% antiretroviral-naive): 389 initiated NVP and 370 initiated EFV. Baseline IAS-USA NNRTI resistance mutations were detected in 3%. Using the Rega algorithm (version 7.1) to interpret resistance, 460 (64%) patients had resistance (full or intermediate) to at least one drug they were starting (69% NVP, 60% EFV, P = 0.011); 287 (74%) NVP and 168 (45%) EFV patients experienced virological failure after treatment initiation, P < 0.001. After adjustment for previous antiretroviral use, previous AIDS, year started NNRTI, CD4 cell count (baseline, nadir), viral load (baseline, maximum), and baseline drug resistance (measured by Rega), the relative hazards (EFV versus NVP) of virological failure was 0.50, 95% confidence interval: 0.39-0.65, P < 0.001. At time of virological failure, comparable levels of NNRTI resistance were detected. The K103N mutation emerged more in patients failing EFV and Y181C in patients failing NVP.NVP may be associated with an inferior virological outcome compared to EFV in NNRTI-naive patients with extensive resistance to other drug classes. The profile of NNRTI resistance mutations when virologically failing an NNRTI-containing regimen appears to depend on the NNRTI the patients fail.