Objective: The study aim was to determine how resistance testing influences outcome of first-line highly active antiretroviral 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 HAART regimens were determined using data from the UK Collaborative HIV Cohort (CHIC) Study. Factors associated with starting a regimen with a reduced GSS and subsequent virological responses were analyzed by logistic and Cox regression. Results: Amongst patients tested in 1999-2006, 116 of 1175 (10%) had ≥1 resistance mutation; 64 patients (5.4%) had ≥1 mutation associated with resistance to drugs in the initial HAART regimen and 54 (4.6%) showed a GSS <3. Factors independently 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 of ritonavir-boosted protease inhibitor (PI/r)-based vs. nonnucleoside reverse transcriptase inhibitor-based regimens (1.97; 1.06 to 3.64). A GSS >3 was independently 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 testing received regimens with a GSS <3. PI/r-based therapy was often selected in patients with resistance to the nucleoside reverse transcriptase inhibitor backbone. Low GSS predicted poor virological suppression and the association persisted after adjusting for PI/r use

Bansi, L., Geretti, A.m., Dunn, D., Hill, T., Green, H., Fearnhill, E., et al. (2010). The impact of transmitted drug-resistance on treatment selection and outcome of first-line highly active antiretroviral therapy (HAART). JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 53(5), 633-639 [10.1097/QAI.0b013e3181c070d2].

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

Geretti, A. M.;
2010-01-01

Abstract

Objective: The study aim was to determine how resistance testing influences outcome of first-line highly active antiretroviral 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 HAART regimens were determined using data from the UK Collaborative HIV Cohort (CHIC) Study. Factors associated with starting a regimen with a reduced GSS and subsequent virological responses were analyzed by logistic and Cox regression. Results: Amongst patients tested in 1999-2006, 116 of 1175 (10%) had ≥1 resistance mutation; 64 patients (5.4%) had ≥1 mutation associated with resistance to drugs in the initial HAART regimen and 54 (4.6%) showed a GSS <3. Factors independently 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 of ritonavir-boosted protease inhibitor (PI/r)-based vs. nonnucleoside reverse transcriptase inhibitor-based regimens (1.97; 1.06 to 3.64). A GSS >3 was independently 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 testing received regimens with a GSS <3. PI/r-based therapy was often selected in patients with resistance to the nucleoside reverse transcriptase inhibitor backbone. Low GSS predicted poor virological suppression and the association persisted after adjusting for PI/r use
2010
Pubblicato
Rilevanza internazionale
Articolo
Esperti anonimi
Settore MEDS-10/B - Malattie infettive
English
First-line HAART
Genotype
HIV
Transmitted drug resistance
Bansi, L., Geretti, A.m., Dunn, D., Hill, T., Green, H., Fearnhill, E., et al. (2010). The impact of transmitted drug-resistance on treatment selection and outcome of first-line highly active antiretroviral therapy (HAART). JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES, 53(5), 633-639 [10.1097/QAI.0b013e3181c070d2].
Bansi, L; Geretti, Am; Dunn, D; Hill, T; Green, H; Fearnhill, E; Gazzard, B; Nelson, M; Porter, K; Phillips, A; Sabin, C
Articolo su rivista
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2108/410565
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