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Impact of Human Immunodeficiency Virus Drug Resistance Mutations Detected in Women Prior to Antiretroviral Therapy With Efavirenz + Tenofovir Disoproxil Fumarate + Lamivudine (or Emtricitabine).
Boyce, Ceejay L; Sils, Tatiana; Milne, Ross S; Wallner, Jackson J; Hardy, Samantha R; Ko, Daisy; Wong-On-Wing, Annie; Mackey, Malia; Higa, Nikki; Beck, Ingrid A; Styrchak, Sheila M; DeMarrais, Patricia; Tierney, Camlin; Fowler, Mary G; Frenkel, Lisa M.
Afiliación
  • Boyce CL; Department of Global Health, University of Washington, Seattle, Washington, USA.
  • Sils T; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Milne RS; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Wallner JJ; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Hardy SR; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Ko D; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Wong-On-Wing A; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Mackey M; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Higa N; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Beck IA; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Styrchak SM; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • DeMarrais P; Center for Global Infectious Disease Research, Seattle Children's Research Institute, Seattle, Washington, USA.
  • Tierney C; Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Fowler MG; Center for Biostatistics in AIDS Research, Harvard T. H. Chan School of Public Health, Boston, Massachusetts, USA.
  • Frenkel LM; Department of Pathology, Johns Hopkins University, Baltimore, Maryland, USA.
Open Forum Infect Dis ; 11(7): ofae383, 2024 Jul.
Article en En | MEDLINE | ID: mdl-39050228
ABSTRACT

Background:

Two large studies suggest that resistance mutations to only nonnucleoside reverse transcriptase inhibitors (NNRTI) did not increase the risk of virologic failure during antiretroviral therapy (ART) with efavirenz/tenofovir disoproxil fumarate/lamivudine (or emtricitabine). We retrospectively evaluated a third cohort to determine the impact of NNRTI resistance on the efficacy of efavirenz-based ART.

Methods:

Postpartum women living with human immunodeficiency virus (HIV) were studied if they initiated efavirenz-based ART because of the World Health Organization's recommendation for universal ART. Resistance was detected by Sanger genotyping plasma prior to efavirenz-based ART and at virologic failure (HIV RNA >400 copies/mL). Logistic regression examined relationships between pre-efavirenz genotypes and virologic failure.

Results:

Pre-efavirenz resistance was detected in 169 of 1223 (13.8%) participants. By month 12 of efavirenz-based ART, 189 of 1233 (15.3%) participants had virologic failure. Rates of virologic failure did not differ by pre-efavirenz NNRTI resistance. However, while pre-efavirenz nucleos(t)ide reverse transcriptase inhibitors (NRTI) and NNRTI resistance was rare (8/1223 [0.7%]) this genotype increased the odds (adjusted odds ratio, 11.2 [95% confidence interval, 2.21-72.2]) of virologic failure during efavirenz-based ART. Age, time interval between last viremic visit and efavirenz initiation, clinical site, viremia at delivery, hepatitis B virus coinfection, and antepartum regimen were also associated with virologic failure.

Conclusions:

Resistance to NNRTI alone was prevalent and dual-class (NRTI and NNRTI) resistance was rare in this cohort, with only the latter associated with virologic failure. This confirms others' findings that, if needed, efavirenz-based ART offers most people an effective alternative to dolutegravir-based ART.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Open Forum Infect Dis Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Open Forum Infect Dis Año: 2024 Tipo del documento: Article País de afiliación: Estados Unidos Pais de publicación: Estados Unidos