Journal Article

Predictors of Virologic Failure and Resistance in HIV-Infected Patients Treated with Nevirapine- or Efavirenz-Based Antiretroviral Therapy

Jean-Jacques Parienti, Véronique Massari, Diane Descamps, Astrid Vabret, Elisabeth Bouvet, Bernard Larouzé and Renaud Verdon

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 38, issue 9, pages 1311-1316
Published in print May 2004 | ISSN: 1058-4838
Published online May 2004 | e-ISSN: 1537-6591 | DOI: http://dx.doi.org/10.1086/383572
Predictors of Virologic Failure and Resistance in HIV-Infected Patients Treated with Nevirapine- or Efavirenz-Based Antiretroviral Therapy

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Resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs) increases with the wider use of this class of antiretroviral therapy. The association between adherence and resistance to NNRTI-based regimens is poorly understood. Predictors of virologic failure and resistance according to a baseline evaluation of nonadherence risk factors were determined in a cohort of 71 human immunodeficiency virus (HIV)—infected patients with early virologic response who received an NNRTI-based regimen. During the median follow-up of 29 months, 20 (28%) of 71 patients experienced virologic failure with an NNRTI-based regimen. Virologic failure was associated with repeated drug holidays (⩾48 h of unplanned drug cessation), depression, younger age, and low adherence to therapy during baseline evaluation. Moreover, repeated drug holidays was the only risk factor for developing a major mutation conferring cross-resistance to the NNRTI class (hazard ratio, 22.5; 95% confidence interval, 2.8–180.3; P < .0001). Patients' previous adherence to therapy and drugs genetic barriers, not only the number of pills or doses involved, should be taken into consideration in the decision to simplify highly active antiretroviral therapy.

Journal Article.  3374 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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