HIV multi‐drug resistance at first‐line antiretroviral failure and subsequent virological response in Asia

Abstract

Introduction First‐line antiretroviral therapy (ART) failure often results from the development of resistance‐associated mutations (RAMs). Three patterns, including thymidine analogue mutations (TAMs), 69 Insertion (69Ins) and the Q151M complex, are associated with resistance to multiple‐nucleoside reverse transcriptase inhibitors (NRTIs) and may compromise treatment options for second‐line ART. Methods We investigated patterns and factors associated with multi‐NRTI RAMs at first‐line failure in patients from The TREAT Asia Studies to Evaluate Resistance – Monitoring study (TASER‐M), and evaluated their impact on virological responses at 12 months after switching to second‐line ART. RAMs were compared with the IAS‐USA 2013 mutations list. We defined multi‐NRTI RAMs as the presence of either Q151M; 69Ins; ≥2 TAMs; or M184V+≥1 TAM. Virological suppression was defined as viral load (VL) 2 years (OR=6.25, 95% CI [2.39–16.36], p<0.001). Among 87/105 patients with available VL at 12 months after switch to second‐line ART, virological suppression was achieved in 85%. The median genotypic susceptibility score (GSS) for the second‐line regimen was 2.00. Patients with ART adherence ≥95% were more likely to be virologically suppressed (OR=9.33, 95% CI (2.43–35.81), p=0.001). Measures of patient resistance to second‐line ART, including the GSS, were not significantly associated with virological outcome. Conclusions Multi‐NRTI RAMs at first‐line failure were associated with low CD4 level and longer duration of ART. With many patients switching to highly susceptible regimens, good adherence was still crucial in achieving virological response. This emphasizes the importance of continued adherence counselling well into second‐line therapy.

Keywords

• HIV
• resource‐limited
• resistance
• mutations
• failure