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Predictors
of Virologic Failure and Resistance in HIV Patients Treated with
NNRTI Therapy
Resistance
to non nucleoside 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.
In
the current study, 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
a nevirapine (Viramune)-
or efavirenz (Sustiva)-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).
The
authors conclude, “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.”
04/21/04
Reference
J
Jacques Parienti and others. Predictors of Virologic Failure
and Resistance in HIV-Infected
Patients Treated with Nevirapine-
or Efavirenz-Based Antiretroviral
Therapy. Clinical Infectious Diseases 38:1311-1316. May 1, 2004.
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