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

Wendy P. Bannister; Lidia Ruiz; Alessandro Cozzi-Lepri; Amanda Mocroft; Ole Kirk; Schlomo Staszewski; Clive Loveday; Anders Karlsson; Antonella D.Arminio Monforte; Bonaventura Clotet; Jens D. Lundgren; M. Losso; A. Duran; N. Vetter; I. Karpov; A. Vassilenko; N. Clumeck; S. DeWit; B. Poll; R. Colebunders; K. Kostov; J. Begovac; M. Ristola; L. Machala; H. Rozsypal; D. Sedlacek; J. Nielsen; T. Benfield; J. Gerstoft; T. Katzenstein; A. B.E. Hansen; P. Skinhøj; C. Pedersen; L. Oestergaard; K. Zilmer; J. Smidt; C. Katlama; J. P. Viard; P. M. Girard; J. M. Livrozet; P. Vanhems; C. Pradier; F. Dabis; J. Rockstroh; R. Schmidt; J. Van Lunzen; O. Degen; H. J. Stellbrink; J. Bogner; G. Fätkenheuer; J. Kosmidis; P. Gargalianos; G. Xylomenos; J. Perdios; G. Panos; A. Filandras; E. Karabatsaki; H. Sambattakou; D. Banhegyi; F. Mulcahy; I. Yust; D. Turner; M. Burke; S. Pollack; G. Hassoun; S. Maayan; A. Chiesi; R. Esposito; I. Mazeu; C. Mussini; C. Arici; R. Pristera; F. Mazzotta; A. Gabbuti; V. Vullo; M. Lichtner; A. Chirianni; E. Montesarchio; M. Gargiulo; G. Antonucci; F. Iacomi; P. Narciso; C. Vlassi; M. Zaccarelli; A. Lazzarin; R. Finazzi; M. Galli; A. Ridolfo; A. D'Arminio Monforte; B. Rozentale; P. Aldins; S. Chaplinskas; R. Hemmer; T. Staub; P. Reiss; J. Bruun; A. Maeland; V. Ormaasen; B. Knysz; J. Gasiorowski; A. Horban; D. Prokopowicz; A. Wiercinska-Drapalo; A. Boron-Kaczmarska; M. Pynka; M. Beniowski; E. Mularska; H. Trocha; F. Antunes; E. Valadas; K. Mansinho; F. Maltez; D. Duiculescu; A. Rakhmanova; E. Vinogradova; S. Buzunova; D. Jevtovic; M. Mokráš; D. Staneková; J. González-Lahoz; V. Soriano; L. Martin-Carbonero; P. Labarga; A. Jou; J. Conejero; C. Tural; J. M. Gatell; J. M. Miró; P. Domingo; M. Gutierrez; G. Mateo; M. A. Sambeat; P. O. Persson; L. Flamholc; B. Ledergerber; R. Weber; P. Francioli; M. Cavassini; B. Hirschel; E. Boffi; H. Furrer; M. Battegay; L. Elzi; E. Kravchenko; N. Chentsova; S. Barton; A. M. Johnson; D. Mercey; A. Phillips; M. A. Johnson; M. Murphy; J. Weber; G. Scullard; M. Fisher; R. Brettle; B. Gazzard; A. D'Arminio Montforte; N. Friis-Moller; M. Ellefson; A. Borch; D. Podlevkareva; C. Holkmann Olsen; J. Kjar; L. Peters; J. Reekie; W. Bannister

doi:10.1097/QAD.0b013e3282f3cc35

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

Wendy P. Bannister^*, Lidia Ruiz, Alessandro Cozzi-Lepri, Amanda Mocroft, Ole Kirk, Schlomo Staszewski, Clive Loveday, Anders Karlsson, Antonella D.Arminio Monforte, Bonaventura Clotet, Jens D. Lundgren, M. Losso, A. Duran, N. Vetter, I. Karpov, A. Vassilenko, N. Clumeck, S. DeWit, B. Poll, R. ColebundersK. Kostov, J. Begovac, M. Ristola, L. Machala, H. Rozsypal, D. Sedlacek, J. Nielsen, T. Benfield, J. Gerstoft, T. Katzenstein, A. B.E. Hansen, P. Skinhøj, C. Pedersen, L. Oestergaard, K. Zilmer, J. Smidt, C. Katlama, J. P. Viard, P. M. Girard, J. M. Livrozet, P. Vanhems, C. Pradier, F. Dabis, J. Rockstroh, R. Schmidt, J. Van Lunzen, O. Degen, H. J. Stellbrink, J. Bogner, G. Fätkenheuer, J. Kosmidis, P. Gargalianos, G. Xylomenos, J. Perdios, G. Panos, A. Filandras, E. Karabatsaki, H. Sambattakou, D. Banhegyi, F. Mulcahy, I. Yust, D. Turner, M. Burke, S. Pollack, G. Hassoun, S. Maayan, A. Chiesi, R. Esposito, I. Mazeu, C. Mussini, C. Arici, R. Pristera, F. Mazzotta, A. Gabbuti, V. Vullo, M. Lichtner, A. Chirianni, E. Montesarchio, M. Gargiulo, G. Antonucci, F. Iacomi, P. Narciso, C. Vlassi, M. Zaccarelli, A. Lazzarin, R. Finazzi, M. Galli, A. Ridolfo, A. D'Arminio Monforte, B. Rozentale, P. Aldins, S. Chaplinskas, R. Hemmer, T. Staub, P. Reiss, J. Bruun, A. Maeland, V. Ormaasen, B. Knysz, J. Gasiorowski, A. Horban, D. Prokopowicz, A. Wiercinska-Drapalo, A. Boron-Kaczmarska, M. Pynka, M. Beniowski, E. Mularska, H. Trocha, F. Antunes, E. Valadas, K. Mansinho, F. Maltez, D. Duiculescu, A. Rakhmanova, E. Vinogradova, S. Buzunova, D. Jevtovic, M. Mokráš, D. Staneková, J. González-Lahoz, V. Soriano, L. Martin-Carbonero, P. Labarga, A. Jou, J. Conejero, C. Tural, J. M. Gatell, J. M. Miró, P. Domingo, M. Gutierrez, G. Mateo, M. A. Sambeat, P. O. Persson, L. Flamholc, B. Ledergerber, R. Weber, P. Francioli, M. Cavassini, B. Hirschel, E. Boffi, H. Furrer, M. Battegay, L. Elzi, E. Kravchenko, N. Chentsova, S. Barton, A. M. Johnson, D. Mercey, A. Phillips, M. A. Johnson, M. Murphy, J. Weber, G. Scullard, M. Fisher, R. Brettle, B. Gazzard, A. D'Arminio Montforte, N. Friis-Moller, M. Ellefson, A. Borch, D. Podlevkareva, C. Holkmann Olsen, J. Kjar, L. Peters, J. Reekie, W. Bannister

^*Corresponding author for this work

Research output: Contribution to journal › Article › peer-review

41 Scopus citations

Abstract

OBJECTIVE: To compare virological outcome and genotypic resistance profiles in HIV-1-infected patients starting non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimens. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

Original language	English
Pages (from-to)	367-376
Number of pages	10
Journal	AIDS
Volume	22
Issue number	3
DOIs	https://doi.org/10.1097/QAD.0b013e3282f3cc35
State	Published - 1 Jan 2008
Externally published	Yes

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10.1097/QAD.0b013e3282f3cc35

Cite this

Bannister, W. P., Ruiz, L., Cozzi-Lepri, A., Mocroft, A., Kirk, O., Staszewski, S., Loveday, C., Karlsson, A., Monforte, A. D. A., Clotet, B., Lundgren, J. D., Losso, M., Duran, A., Vetter, N., Karpov, I., Vassilenko, A., Clumeck, N., DeWit, S., Poll, B., ... Bannister, W. (2008). Comparison of genotypic resistance profiles and virological response between patients starting nevirapine and efavirenz in EuroSIDA. AIDS, 22(3), 367-376. https://doi.org/10.1097/QAD.0b013e3282f3cc35

@article{35f6405e6c5249ae8d933d51adab3729,

title = "Comparison of genotypic resistance profiles and virological response between patients starting nevirapine and efavirenz in EuroSIDA",

abstract = "OBJECTIVE: To compare virological outcome and genotypic resistance profiles in HIV-1-infected patients starting non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimens. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.",

author = "Bannister, {Wendy P.} and Lidia Ruiz and Alessandro Cozzi-Lepri and Amanda Mocroft and Ole Kirk and Schlomo Staszewski and Clive Loveday and Anders Karlsson and Monforte, {Antonella D.Arminio} and Bonaventura Clotet and Lundgren, {Jens D.} and M. Losso and A. Duran and N. Vetter and I. Karpov and A. Vassilenko and N. Clumeck and S. DeWit and B. Poll and R. Colebunders and K. Kostov and J. Begovac and M. Ristola and L. Machala and H. Rozsypal and D. Sedlacek and J. Nielsen and T. Benfield and J. Gerstoft and T. Katzenstein and Hansen, {A. B.E.} and P. Skinh{\o}j and C. Pedersen and L. Oestergaard and K. Zilmer and J. Smidt and C. Katlama and Viard, {J. P.} and Girard, {P. M.} and Livrozet, {J. M.} and P. Vanhems and C. Pradier and F. Dabis and J. Rockstroh and R. Schmidt and {Van Lunzen}, J. and O. Degen and Stellbrink, {H. J.} and J. Bogner and G. F{\"a}tkenheuer and J. Kosmidis and P. Gargalianos and G. Xylomenos and J. Perdios and G. Panos and A. Filandras and E. Karabatsaki and H. Sambattakou and D. Banhegyi and F. Mulcahy and I. Yust and D. Turner and M. Burke and S. Pollack and G. Hassoun and S. Maayan and A. Chiesi and R. Esposito and I. Mazeu and C. Mussini and C. Arici and R. Pristera and F. Mazzotta and A. Gabbuti and V. Vullo and M. Lichtner and A. Chirianni and E. Montesarchio and M. Gargiulo and G. Antonucci and F. Iacomi and P. Narciso and C. Vlassi and M. Zaccarelli and A. Lazzarin and R. Finazzi and M. Galli and A. Ridolfo and {D'Arminio Monforte}, A. and B. Rozentale and P. Aldins and S. Chaplinskas and R. Hemmer and T. Staub and P. Reiss and J. Bruun and A. Maeland and V. Ormaasen and B. Knysz and J. Gasiorowski and A. Horban and D. Prokopowicz and A. Wiercinska-Drapalo and A. Boron-Kaczmarska and M. Pynka and M. Beniowski and E. Mularska and H. Trocha and F. Antunes and E. Valadas and K. Mansinho and F. Maltez and D. Duiculescu and A. Rakhmanova and E. Vinogradova and S. Buzunova and D. Jevtovic and M. Mokr{\'a}{\v s} and D. Stanekov{\'a} and J. Gonz{\'a}lez-Lahoz and V. Soriano and L. Martin-Carbonero and P. Labarga and A. Jou and J. Conejero and C. Tural and Gatell, {J. M.} and Mir{\'o}, {J. M.} and P. Domingo and M. Gutierrez and G. Mateo and Sambeat, {M. A.} and Persson, {P. O.} and L. Flamholc and B. Ledergerber and R. Weber and P. Francioli and M. Cavassini and B. Hirschel and E. Boffi and H. Furrer and M. Battegay and L. Elzi and E. Kravchenko and N. Chentsova and S. Barton and Johnson, {A. M.} and D. Mercey and A. Phillips and Johnson, {M. A.} and M. Murphy and J. Weber and G. Scullard and M. Fisher and R. Brettle and B. Gazzard and {D'Arminio Montforte}, A. and N. Friis-Moller and M. Ellefson and A. Borch and D. Podlevkareva and {Holkmann Olsen}, C. and J. Kjar and L. Peters and J. Reekie and W. Bannister",

year = "2008",

month = jan,

day = "1",

doi = "10.1097/QAD.0b013e3282f3cc35",

language = "אנגלית",

volume = "22",

pages = "367--376",

journal = "AIDS",

issn = "0269-9370",

publisher = "Lippincott Williams and Wilkins",

number = "3",

}

Bannister, WP, Ruiz, L, Cozzi-Lepri, A, Mocroft, A, Kirk, O, Staszewski, S, Loveday, C, Karlsson, A, Monforte, ADA, Clotet, B, Lundgren, JD, Losso, M, Duran, A, Vetter, N, Karpov, I, Vassilenko, A, Clumeck, N, DeWit, S, Poll, B, Colebunders, R, Kostov, K, Begovac, J, Ristola, M, Machala, L, Rozsypal, H, Sedlacek, D, Nielsen, J, Benfield, T, Gerstoft, J, Katzenstein, T, Hansen, ABE, Skinhøj, P, Pedersen, C, Oestergaard, L, Zilmer, K, Smidt, J, Katlama, C, Viard, JP, Girard, PM, Livrozet, JM, Vanhems, P, Pradier, C, Dabis, F, Rockstroh, J, Schmidt, R, Van Lunzen, J, Degen, O, Stellbrink, HJ, Bogner, J, Fätkenheuer, G, Kosmidis, J, Gargalianos, P, Xylomenos, G, Perdios, J, Panos, G, Filandras, A, Karabatsaki, E, Sambattakou, H, Banhegyi, D, Mulcahy, F, Yust, I , Turner, D, Burke, M, Pollack, S, Hassoun, G, Maayan, S, Chiesi, A, Esposito, R, Mazeu, I, Mussini, C, Arici, C, Pristera, R, Mazzotta, F, Gabbuti, A, Vullo, V, Lichtner, M, Chirianni, A, Montesarchio, E, Gargiulo, M, Antonucci, G, Iacomi, F, Narciso, P, Vlassi, C, Zaccarelli, M, Lazzarin, A, Finazzi, R, Galli, M, Ridolfo, A, D'Arminio Monforte, A, Rozentale, B, Aldins, P, Chaplinskas, S, Hemmer, R, Staub, T, Reiss, P, Bruun, J, Maeland, A, Ormaasen, V, Knysz, B, Gasiorowski, J, Horban, A, Prokopowicz, D, Wiercinska-Drapalo, A, Boron-Kaczmarska, A, Pynka, M, Beniowski, M, Mularska, E, Trocha, H, Antunes, F, Valadas, E, Mansinho, K, Maltez, F, Duiculescu, D, Rakhmanova, A, Vinogradova, E, Buzunova, S, Jevtovic, D, Mokráš, M, Staneková, D, González-Lahoz, J, Soriano, V, Martin-Carbonero, L, Labarga, P, Jou, A, Conejero, J, Tural, C, Gatell, JM, Miró, JM, Domingo, P, Gutierrez, M, Mateo, G, Sambeat, MA, Persson, PO, Flamholc, L, Ledergerber, B, Weber, R, Francioli, P, Cavassini, M, Hirschel, B, Boffi, E, Furrer, H, Battegay, M, Elzi, L, Kravchenko, E, Chentsova, N, Barton, S, Johnson, AM, Mercey, D, Phillips, A, Johnson, MA, Murphy, M, Weber, J, Scullard, G, Fisher, M, Brettle, R, Gazzard, B, D'Arminio Montforte, A, Friis-Moller, N, Ellefson, M, Borch, A, Podlevkareva, D, Holkmann Olsen, C, Kjar, J, Peters, L, Reekie, J & Bannister, W 2008, 'Comparison of genotypic resistance profiles and virological response between patients starting nevirapine and efavirenz in EuroSIDA', AIDS, vol. 22, no. 3, pp. 367-376. https://doi.org/10.1097/QAD.0b013e3282f3cc35

TY - JOUR

T1 - Comparison of genotypic resistance profiles and virological response between patients starting nevirapine and efavirenz in EuroSIDA

AU - Bannister, Wendy P.

AU - Ruiz, Lidia

AU - Cozzi-Lepri, Alessandro

AU - Mocroft, Amanda

AU - Kirk, Ole

AU - Staszewski, Schlomo

AU - Loveday, Clive

AU - Karlsson, Anders

AU - Monforte, Antonella D.Arminio

AU - Clotet, Bonaventura

AU - Lundgren, Jens D.

AU - Losso, M.

AU - Duran, A.

AU - Vetter, N.

AU - Karpov, I.

AU - Vassilenko, A.

AU - Clumeck, N.

AU - DeWit, S.

AU - Poll, B.

AU - Colebunders, R.

AU - Kostov, K.

AU - Begovac, J.

AU - Ristola, M.

AU - Machala, L.

AU - Rozsypal, H.

AU - Sedlacek, D.

AU - Nielsen, J.

AU - Benfield, T.

AU - Gerstoft, J.

AU - Katzenstein, T.

AU - Hansen, A. B.E.

AU - Skinhøj, P.

AU - Pedersen, C.

AU - Oestergaard, L.

AU - Zilmer, K.

AU - Smidt, J.

AU - Katlama, C.

AU - Viard, J. P.

AU - Girard, P. M.

AU - Livrozet, J. M.

AU - Vanhems, P.

AU - Pradier, C.

AU - Dabis, F.

AU - Rockstroh, J.

AU - Schmidt, R.

AU - Van Lunzen, J.

AU - Degen, O.

AU - Stellbrink, H. J.

AU - Bogner, J.

AU - Fätkenheuer, G.

AU - Kosmidis, J.

AU - Gargalianos, P.

AU - Xylomenos, G.

AU - Perdios, J.

AU - Panos, G.

AU - Filandras, A.

AU - Karabatsaki, E.

AU - Sambattakou, H.

AU - Banhegyi, D.

AU - Mulcahy, F.

AU - Yust, I.

AU - Turner, D.

AU - Burke, M.

AU - Pollack, S.

AU - Hassoun, G.

AU - Maayan, S.

AU - Chiesi, A.

AU - Esposito, R.

AU - Mazeu, I.

AU - Mussini, C.

AU - Arici, C.

AU - Pristera, R.

AU - Mazzotta, F.

AU - Gabbuti, A.

AU - Vullo, V.

AU - Lichtner, M.

AU - Chirianni, A.

AU - Montesarchio, E.

AU - Gargiulo, M.

AU - Antonucci, G.

AU - Iacomi, F.

AU - Narciso, P.

AU - Vlassi, C.

AU - Zaccarelli, M.

AU - Lazzarin, A.

AU - Finazzi, R.

AU - Galli, M.

AU - Ridolfo, A.

AU - D'Arminio Monforte, A.

AU - Rozentale, B.

AU - Aldins, P.

AU - Chaplinskas, S.

AU - Hemmer, R.

AU - Staub, T.

AU - Reiss, P.

AU - Bruun, J.

AU - Maeland, A.

AU - Ormaasen, V.

AU - Knysz, B.

AU - Gasiorowski, J.

AU - Horban, A.

AU - Prokopowicz, D.

AU - Wiercinska-Drapalo, A.

AU - Boron-Kaczmarska, A.

AU - Pynka, M.

AU - Beniowski, M.

AU - Mularska, E.

AU - Trocha, H.

AU - Antunes, F.

AU - Valadas, E.

AU - Mansinho, K.

AU - Maltez, F.

AU - Duiculescu, D.

AU - Rakhmanova, A.

AU - Vinogradova, E.

AU - Buzunova, S.

AU - Jevtovic, D.

AU - Mokráš, M.

AU - Staneková, D.

AU - González-Lahoz, J.

AU - Soriano, V.

AU - Martin-Carbonero, L.

AU - Labarga, P.

AU - Jou, A.

AU - Conejero, J.

AU - Tural, C.

AU - Gatell, J. M.

AU - Miró, J. M.

AU - Domingo, P.

AU - Gutierrez, M.

AU - Mateo, G.

AU - Sambeat, M. A.

AU - Persson, P. O.

AU - Flamholc, L.

AU - Ledergerber, B.

AU - Weber, R.

AU - Francioli, P.

AU - Cavassini, M.

AU - Hirschel, B.

AU - Boffi, E.

AU - Furrer, H.

AU - Battegay, M.

AU - Elzi, L.

AU - Kravchenko, E.

AU - Chentsova, N.

AU - Barton, S.

AU - Johnson, A. M.

AU - Mercey, D.

AU - Phillips, A.

AU - Johnson, M. A.

AU - Murphy, M.

AU - Weber, J.

AU - Scullard, G.

AU - Fisher, M.

AU - Brettle, R.

AU - Gazzard, B.

AU - D'Arminio Montforte, A.

AU - Friis-Moller, N.

AU - Ellefson, M.

AU - Borch, A.

AU - Podlevkareva, D.

AU - Holkmann Olsen, C.

AU - Kjar, J.

AU - Peters, L.

AU - Reekie, J.

AU - Bannister, W.

PY - 2008/1/1

Y1 - 2008/1/1

N2 - OBJECTIVE: To compare virological outcome and genotypic resistance profiles in HIV-1-infected patients starting non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimens. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

AB - OBJECTIVE: To compare virological outcome and genotypic resistance profiles in HIV-1-infected patients starting non-nucleoside reverse transcriptase inhibitor (NNRTI)-containing regimens. METHODS: 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). RESULTS: 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. CONCLUSIONS: 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.

UR - http://www.scopus.com/inward/record.url?scp=38149112713&partnerID=8YFLogxK

U2 - 10.1097/QAD.0b013e3282f3cc35

DO - 10.1097/QAD.0b013e3282f3cc35

M3 - ???researchoutput.researchoutputtypes.contributiontojournal.article???

C2 - 18195563

AN - SCOPUS:38149112713

SN - 0269-9370

VL - 22

SP - 367

EP - 376

JO - AIDS

JF - AIDS

IS - 3

ER -

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

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