The impact of transmitted drug resistance on treatment selection and outcome of first-line highly active antiretroviral therapy (HAART)
Bansi, L.
The impact of transmitted drug resistance on treatment selection and outcome of first-line highly active antiretroviral therapy (HAART) - 2010
NMUH Staff Publications 53
<p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US">OBJECTIVE:</span></strong><span lang="EN-US"> The study aim was to determine howresistance testing influences outcome of first-line highly activeantiretroviral therapy (HAART) in routine practice in the United Kingdom.</span></p><p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US" style="text-transform:uppercase;mso-ansi-language:
EN-US">METHODS:</span></strong><span lang="EN-US" style="text-transform:uppercase;
mso-ansi-language:EN-US"> </span><span lang="EN-US">The prevalence of transmitted</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">drug</span></span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span lang="EN-US">resistance and the genotypic sensitivity score (GSS) of first-line HAARTregimens were determined using</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">data</span></span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span lang="EN-US">from the UK Collaborative HIV Cohort(CHIC) Study. Factors associatedwith starting a regimen with a reduced GSS and subsequent virological responseswere analyzed by logistic and Cox regression.</span></p><p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US" style="text-transform:uppercase;mso-ansi-language:
EN-US">RESULTS:</span></strong><span lang="EN-US" style="text-transform:uppercase;
mso-ansi-language:EN-US"> </span><span lang="EN-US">Amongst patients tested in 1999–2006, 116 of 1175 (10%) had $1resistance</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">mutation</span></span><span lang="EN-US">;64 patients (5.4%) had $1</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">mutation</span></span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span lang="EN-US">associated with resistance to drugsin the initial HAART regimen and 54 (4.6%) showed a GSS, 3. Factorsindependently associated with a GSS, 3 were starting HAART in 1999–2001 vs.2004–2006 (odds ratio = 2.63; 95% confidence interval: 1.19 to 5.83) and use ofritonavir-boosted protease inhibitor (PI/r)–based vs. nonnucleoside reversetranscriptase inhibitor–based regimens (1.97; 1.06 to 3.64). AGSS .3 wasindependently associated with virological suppression(hazard ratio for GSS, 3 =0.60; 95% confidence interval 0.41 to 0.87).<span style="text-transform:uppercase"></span></span></p><p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US" style="text-transform:uppercase;mso-ansi-language:
EN-US">CONCLUSIONS:</span></strong><span lang="EN-US" style="text-transform:uppercase;
mso-ansi-language:EN-US"> </span><span lang="EN-US">Most patients starting HAART after undergoing resistance testingreceived regimens with a GSS $3. PI/r-based therapy was often selected inpatients with resistance to the nucleoside reverse transcriptase inhibitorbackbone. Low GSS predicted poor virological suppression and the associationpersisted after adjusting for PI/r use<span style="text-transform:uppercase"></span></span></p>
15254135
The impact of transmitted drug resistance on treatment selection and outcome of first-line highly active antiretroviral therapy (HAART) - 2010
NMUH Staff Publications 53
<p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US">OBJECTIVE:</span></strong><span lang="EN-US"> The study aim was to determine howresistance testing influences outcome of first-line highly activeantiretroviral therapy (HAART) in routine practice in the United Kingdom.</span></p><p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US" style="text-transform:uppercase;mso-ansi-language:
EN-US">METHODS:</span></strong><span lang="EN-US" style="text-transform:uppercase;
mso-ansi-language:EN-US"> </span><span lang="EN-US">The prevalence of transmitted</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">drug</span></span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span lang="EN-US">resistance and the genotypic sensitivity score (GSS) of first-line HAARTregimens were determined using</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">data</span></span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span lang="EN-US">from the UK Collaborative HIV Cohort(CHIC) Study. Factors associatedwith starting a regimen with a reduced GSS and subsequent virological responseswere analyzed by logistic and Cox regression.</span></p><p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US" style="text-transform:uppercase;mso-ansi-language:
EN-US">RESULTS:</span></strong><span lang="EN-US" style="text-transform:uppercase;
mso-ansi-language:EN-US"> </span><span lang="EN-US">Amongst patients tested in 1999–2006, 116 of 1175 (10%) had $1resistance</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">mutation</span></span><span lang="EN-US">;64 patients (5.4%) had $1</span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span class="highlight"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;">mutation</span></span><span class="apple-converted-space"><span lang="EN-US" style="font-size: 7.5pt; font-family: Arial, sans-serif;"> </span></span><span lang="EN-US">associated with resistance to drugsin the initial HAART regimen and 54 (4.6%) showed a GSS, 3. Factorsindependently associated with a GSS, 3 were starting HAART in 1999–2001 vs.2004–2006 (odds ratio = 2.63; 95% confidence interval: 1.19 to 5.83) and use ofritonavir-boosted protease inhibitor (PI/r)–based vs. nonnucleoside reversetranscriptase inhibitor–based regimens (1.97; 1.06 to 3.64). AGSS .3 wasindependently associated with virological suppression(hazard ratio for GSS, 3 =0.60; 95% confidence interval 0.41 to 0.87).<span style="text-transform:uppercase"></span></span></p><p class="MsoNoSpacing" style="text-align:justify"><strong><span lang="EN-US" style="text-transform:uppercase;mso-ansi-language:
EN-US">CONCLUSIONS:</span></strong><span lang="EN-US" style="text-transform:uppercase;
mso-ansi-language:EN-US"> </span><span lang="EN-US">Most patients starting HAART after undergoing resistance testingreceived regimens with a GSS $3. PI/r-based therapy was often selected inpatients with resistance to the nucleoside reverse transcriptase inhibitorbackbone. Low GSS predicted poor virological suppression and the associationpersisted after adjusting for PI/r use<span style="text-transform:uppercase"></span></span></p>
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