The impact of transmitted drug resistance on treatment selection and outcome of first-line highly active antiretroviral therapy (HAART)

By:

Bansi, L

Contributor(s):

Publication details: 2010ISSN:

15254135

Uniform titles:

Journal of AIDS

Online resources:

Summary: OBJECTIVE: The study aim was to determine howresistance testing influences outcome of first-line highly activeantiretroviral 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 HAARTregimens were determined using data from the UK Collaborative HIV Cohort(CHIC) Study. Factors associatedwith starting a regimen with a reduced GSS and subsequent virological responseswere analyzed by logistic and Cox regression.RESULTS: Amongst patients tested in 1999–2006, 116 of 1175 (10%) had $1resistance mutation;64 patients (5.4%) had $1 mutation associated with resistance to drugsin the initial HAART regimen and 54 (4.6%) showed a GSS, 3. Factorsindependently 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 ofritonavir-boosted protease inhibitor (PI/r)–based vs. nonnucleoside reversetranscriptase inhibitor–based regimens (1.97; 1.06 to 3.64). AGSS .3 wasindependently 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 testingreceived regimens with a GSS $3. PI/r-based therapy was often selected inpatients with resistance to the nucleoside reverse transcriptase inhibitorbackbone. Low GSS predicted poor virological suppression and the associationpersisted after adjusting for PI/r use

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NMUH Staff Publications

OBJECTIVE: The study aim was to determine howresistance testing influences outcome of first-line highly activeantiretroviral therapy (HAART) in routine practice in the United Kingdom.METHODS: The prevalence of transmitted&nbsp;drug&nbsp;resistance and the genotypic sensitivity score (GSS) of first-line HAARTregimens were determined using&nbsp;data&nbsp;from the UK Collaborative HIV Cohort(CHIC) Study. Factors associatedwith starting a regimen with a reduced GSS and subsequent virological responseswere analyzed by logistic and Cox regression.RESULTS: Amongst patients tested in 1999–2006, 116 of 1175 (10%) had $1resistance&nbsp;mutation;64 patients (5.4%) had $1&nbsp;mutation&nbsp;associated with resistance to drugsin the initial HAART regimen and 54 (4.6%) showed a GSS, 3. Factorsindependently 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 ofritonavir-boosted protease inhibitor (PI/r)–based vs. nonnucleoside reversetranscriptase inhibitor–based regimens (1.97; 1.06 to 3.64). AGSS .3 wasindependently 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 testingreceived regimens with a GSS $3. PI/r-based therapy was often selected inpatients with resistance to the nucleoside reverse transcriptase inhibitorbackbone. Low GSS predicted poor virological suppression and the associationpersisted after adjusting for PI/r use

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