Adherence as a predictor of the development of class-specific resistance mutations : the Swiss HIV cohort study
JournalArticle (Originalarbeit in einer wissenschaftlichen Zeitschrift)
ID 2250705
Author(s) von Wyl, Viktor; Klimkait, Thomas; Yerly, Sabine; Nicca, Dunja; Furrer, Hansjakob; Cavassini, Matthias; Calmy, Alexandra; Bernasconi, Enos; Böni, Jürg; Aubert, Vincent; Günthard, Huldrych F.; Bucher, Heiner C.; Glass, Tracy R.; Swiss HIV Cohort Study,
Author(s) at UniBasel Glass, Tracy
Year 2013
Title Adherence as a predictor of the development of class-specific resistance mutations : the Swiss HIV cohort study
Journal PLoS ONE
Volume 8
Number 10
Pages / Article-Number e77691
Mesh terms Adult; Anti-Retroviral Agents, pharmacology; Drug Resistance, Viral, physiology; Female; Genotype; Humans; Kaplan-Meier Estimate; Logistic Models; Male; Middle Aged; Mutation
Abstract Non-adherence is one of the strongest predictors of therapeutic failure in HIV-positive patients. Virologic failure with subsequent emergence of resistance reduces future treatment options and long-term clinical success.; Prospective observational cohort study including patients starting new class of antiretroviral therapy (ART) between 2003 and 2010. Participants were naïve to ART class and completed ≥1 adherence questionnaire prior to resistance testing. Outcomes were development of any IAS-USA, class-specific, or M184V mutations. Associations between adherence and resistance were estimated using logistic regression models stratified by ART class.; Of 314 included individuals, 162 started NNRTI and 152 a PI/r regimen. Adherence was similar between groups with 85% reporting adherence ≥95%. Number of new mutations increased with increasing non-adherence. In NNRTI group, multivariable models indicated a significant linear association in odds of developing IAS-USA (odds ratio (OR) 1.66, 95% confidence interval (CI): 1.04-2.67) or class-specific (OR 1.65, 95% CI: 1.00-2.70) mutations. Levels of drug resistance were considerably lower in PI/r group and adherence was only significantly associated with M184V mutations (OR 8.38, 95% CI: 1.26-55.70). Adherence was significantly associated with HIV RNA in PI/r but not NNRTI regimens.; Therapies containing PI/r appear more forgiving to incomplete adherence compared with NNRTI regimens, which allow higher levels of resistance, even with adherence above 95%. However, in failing PI/r regimens good adherence may prevent accumulation of further resistance mutations and therefore help to preserve future drug options. In contrast, adherence levels have little impact on NNRTI treatments once the first mutations have emerged.
Publisher Public Library of Science
ISSN/ISBN 1932-6203
Full Text on edoc Available
Digital Object Identifier DOI 10.1371/journal.pone.0077691
PubMed ID
ISI-Number WOS:000326019400125
Document type (ISI) Journal Article

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