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Date Posted: 18:49:41 07/24/02 Wed
Author: moonotter
Subject: Transmission of NNRTI-Resistant HIV Strains Is Increasing

Transmission of NNRTI-Resistant HIV Strains Is Increasing


Reuters Health Information 2002. © 2002 Reuters Ltd.
Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.


NEW YORK (Reuters Health) Jul 08 - In areas where antiretroviral drug use is common, more than 25% of newly HIV-infected individuals harbor a virus that is resistant to at least one antiretroviral class, according to a report published in the July 10th issue of the Journal of the American Medical Association (JAMA).
However, in the last 5 years, only transmission of nonnucleoside reverse transcriptase inhibitor (NNRTI)-resistant HIV has increased significantly.

To evaluate time trends in primary HIV-1 drug resistance, Dr. Robert M. Grant, from the Gladstone Institute of Virology and Immunology in San Francisco, and colleagues analyzed viral strains from 225 patients who presented with recent HIV infection between June 1996 and June 2001 at San Francisco General Hospital.

The overall prevalence of resistant strains in 2000/2001 was 27.4%, not significantly different from the 25% prevalence found in 1996/1997, the authors note. However, the prevalence of strains that were resistant to at least two antiretroviral classes increased significantly from 2.5% to 13.2% between the two time periods (p = 0.004 for trend).

Of the entire study group, only one patient, seen in 2000/2001, was infected with a strain that was resistant to three antiretroviral classes, the researchers note.

None of the patients seen in 1996/1997 were infected with NNRTI-resistant strains. In contrast, in 2000/2001, 13.2% of patients harbored strains resistant to NNRTIs (p = 0.01 for trend). No significant increase in the prevalence of strains resistant to other antiretroviral classes was noted.

"Primary resistance indicates triple failure of the healthcare system, including failure of drug treatment to control viral replication in the source partner, failure of behavioral prevention in the source partner receiving treatment, and failure of behavioral prevention in the recently infected person," the authors note.

Findings from another study, also reported in JAMA, highlight the clinical significance of NNRTI-resistant strains. Dr. Scott M. Hammer, from Columbia University in New York, and colleagues assessed the outcomes of 481 patients who were treated with dual or single protease inhibitor (PI) therapy after experiencing virologic failure with a PI-containing regimen.

In addition to receiving amprenavir, abacavir, efavirenz, and adefovir, the patients were randomized to receive saquinavir, indinavir, nelfinavir, or placebo twice daily. Therefore, the study included three dual PI groups and one single PI group.

Patients in the dual PI groups were significantly more likely to achieve viral loads less than 200 copies/mL than those in the single PI group (p = 0.002).

Of note in light of the previous study's findings, patients who were na ve to NNRTIs and those whose strains were highly susceptible to efavirenz, in particular, were significantly more likely to achieve adequate viral suppression than their counterparts.

In a related editorial, Dr. Joel D. Trachtenberg and Dr. Merle A. Sande, from the University of Utah in Salt Lake City, comment that both articles "illustrate the importance of the NNRTI class and its pivotal role in the future management of HIV infection."

The current findings are particularly relevant for developing countries, the editorialist note. "Without the ready availability of PIs, preservation of NNRTI susceptibility is clearly a critical factor to ensure a sustained, widespread treatment success in sub-Saharan Africa and other resource-limited areas," they add.

JAMA 2002:288:169-188,239-241.



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