1. Antiretroviral resistance after first-line antiretroviral therapy failure in diverse HIV-1 subtypes in the SECOND-LINE study
- Author
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Lam, EP, Moore, CL, Gotuzzo, E, Nwizu, C, Kamarulzaman, A, Chetchotisakd, P, Van Wyk, J, Teppler, H, Kumarasamy, N, Molina, JM, Emery, S ; https://orcid.org/0000-0001-6072-8309, Cooper, DA ; https://orcid.org/0000-0002-6031-6678, Boyd, MA ; https://orcid.org/0000-0002-6848-3307, Lam, EP, Moore, CL, Gotuzzo, E, Nwizu, C, Kamarulzaman, A, Chetchotisakd, P, Van Wyk, J, Teppler, H, Kumarasamy, N, Molina, JM, Emery, S ; https://orcid.org/0000-0001-6072-8309, Cooper, DA ; https://orcid.org/0000-0002-6031-6678, and Boyd, MA ; https://orcid.org/0000-0002-6848-3307
- Abstract
We investigate mutations and correlates according to HIV-1 subtype after virological failure (VF) of standard first-line antiretroviral therapy (ART) (non-nucleoside/nucleotide reverse transcriptase inhibitor [NNRTI] +2 nucleoside/nucleotide reverse transcriptase inhibitor [N(t)RTI]). SECOND-LINE study participants were assessed at baseline for HIV-1 subtype, demographics, HIV-1 history, ART exposure, viral load (VL), CD4+ count, and genotypic ART resistance. We used backward stepwise multivariate regression (MVR) to assess associations between baseline variables and presence of ≥3 N(t)RTI mutations, ≥1 NNRTI mutation, ≥3 thymidine analog-N(t)RTI [ta-N(t)RTI] mutations (TAMs), the K65/K70 mutation, and predicted etravirine (ETV)/rilpivirine (RPV) activity. The inclusion p-value for MVR was p < .2. The exclusion p-value from stepwise elimination was p > .05. Of 541 participants, 491 (91%) had successfully characterized baseline viral isolates. Subtype distribution: B (n = 123, 25%), C (n = 202, 41%), CRF01-AE (n = 109, 22%), G (n = 25, 5%), and CRF02-AG (n = 27, 5%). Baseline CD4+ 200-394 cells/mm3 were associated with <3 N(t)RTI mutations (OR = 0.47; 95% CI 0.29-0.77; p = .003), absence of the K65/K70 mutation (OR = 0.43; 95% CI 0.26-0.73; p = .002), and higher ETV sensitivity (OR = 0.52; 95% CI 0.35-0.78; p = .002). Recent tenofovir (TDF) use was associated with K65/K70 mutations (OR = 8.91; 95% CI 5.00-15.85; p < .001). Subtype CRF01-AE was associated with ≥3 N(t)RTI mutations (OR = 2.34; 95% CI 1.31-4.17; p = .004) and higher RPV resistance (OR = 2.13; 95% CI 1.30-3.49; p = .003), and subtype C was associated with <3 TAMs (OR = 0.45; 95% CI 0.21-0.99; p = .015). Subtypes CRF01-AE (OR = 2.46; 95% CI 1.26-4.78; p = .008) and G (OR = 4.77; 95% CI 1.44-15.76; p = .01) were associated with K65/K70 mutations. Higher VL at confirmed first-line VF was associated with ≥3 N(t)RTI mutations (OR = 1.39; 95% CI 1.07-1.78; p = .013) and ≥3 TAMs (OR = 1.62; 95% CI 1.15-2.29; p
- Published
- 2016