- 作者：Sasisopin Kiertiburanakul ; Surasak Wiboonchutikul ; Chonlaphat Sukasem ; Wasun Chantratita ; Somnuek Sungkanuparph
- 刊名：Journal of Clinical Virology
- 出版年：2010
- 出版时间：April 2010
- 年：2010
- 卷：47
- 期：4
- 页码：330-334
- 全文大小：139 K
BackgroundNon-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimens have been extensively used for treatment of HIV infection in resource-limited settings. Treatment options after failing an initial regimen are limited because of cross-resistance of NNRTIs.Objective
To determine the factors associated with reduced response to etravirine among patients with virological failure.
Study design
A retrospective study was conducted. We stratified patients into two groups by the total weighted scores of etravirine-resistance-associated mutations (ETV-RAMs), highest response (score 0–2, N = 123) and intermediate and reduced response (score ≥2.5, N = 61). Factors associated with a score of ≥2.5 were evaluated.
Results
There were 184 patients with mean (SD) age of 42 (9) years old and 60 % were males. Of all, 68 % used NNRTI in the failing regimen and 51 % used stavudine/lamivudine as a backbone. Common ETV-RAMs included Y181C (27 % ), G190A (17 % ), and K101E (10 % ). Higher proportion of K101E, K101P, Y181C, G190S, and M230L were found in patients with a score of ≥2.5 (p < 0.05, all). By univariate logistic regression, using protease inhibitor (OR 0.22, 95 % CI 0.07–0.67), nevirapine (OR 10.56, 95 % CI 4.04–27.74), and efavirenz (OR 2.91, 95 % CI 1.01–2.51) in the current regimen were associated with a score of ≥2.5. By multiple logistic regression, only using nevirapine was associated with a score of ≥2.5 (OR 7.61, 95 % CI 2.40–24.06).
Conclusions
Using nevirapine in the failing regimen was associated with intermediate and reduced response to ETV. The recommendation of using nevirapine as a preferred NNRTI should be re-considered in resource-limited settings where efavirenz is accessible.