Back to Search
Start Over
Viral rebound and emergence of drug resistance in the absence of viral load testing: a randomized comparison between zidovudine-lamivudine plus Nevirapine and zidovudine-lamivudine plus Abacavir.
- Source :
-
The Journal of infectious diseases [J Infect Dis] 2010 Jan 01; Vol. 201 (1), pp. 106-13. - Publication Year :
- 2010
-
Abstract
- Background: We investigated virological response and the emergence of resistance in the Nevirapine or Abacavir (NORA) substudy of the Development of Antiretroviral Treatment in Africa (DART) trial.<br />Methods: Six hundred symptomatic antiretroviral-naive human immunodeficiency virus (HIV)-infected adults (CD4 cell count, <200 cells/mm(3)) from 2 Ugandan centers were randomized to receive zidovudine-lamivudine plus abacavir or nevirapine. Virology was performed retrospectively on stored plasma samples at selected time points. In patients with HIV RNA levels >1000 copies/mL, the residual activity of therapy was calculated as the reduction in HIV RNA level, compared with baseline.<br />Results: Overall, HIV RNA levels were lower in the nevirapine group than in the abacavir group at 24 and 48 weeks (P < .001), although no differences were observed at weeks 4 and 12. Virological responses were similar in the 2 treatment groups for baseline HIV RNA level <100,000 copies/mL. The mean residual activity at week 48 was higher for abacavir in the presence of the typically observed resistance pattern of thymidine analogue mutations (TAMs) and M184V (1.47 log(10) copies/mL) than for nevirapine with M184V and nonnucleoside reverse-transcriptase inhibitor mutations, whether accompanied by TAMs (0.96 log(10) copies/mL) or not (1.18 log(10) copies/mL).<br />Conclusions: There was more extensive genotypic resistance in both treatment groups than is generally seen in resource-rich settings. However, significant residual activity was observed among patients with virological failure, particularly those receiving zidovudine-lamivudine plus abacavir.
- Subjects :
- Adult
CD4 Lymphocyte Count
Dideoxynucleosides therapeutic use
Drug Therapy, Combination
Female
Humans
Kaplan-Meier Estimate
Lamivudine therapeutic use
Male
Mutation
Nevirapine therapeutic use
RNA, Viral
Uganda
Viral Load
Zidovudine therapeutic use
Anti-Retroviral Agents therapeutic use
Drug Resistance, Viral genetics
HIV Infections drug therapy
HIV Infections virology
Subjects
Details
- Language :
- English
- ISSN :
- 1537-6613
- Volume :
- 201
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of infectious diseases
- Publication Type :
- Academic Journal
- Accession number :
- 19938977
- Full Text :
- https://doi.org/10.1086/648590