Viral Rebound and Emergence of Drug Resistance in the Absence of Viral Load Testing: A Randomized Comparison between Zidovudine-Lamivudine plus Nevirapine and Zidovudine-Lamivudine plus Abacavir.
Abstract
Background: We investigated virological response and the emergence of resistance in the Nevirapine or Abacavir (NORA) substudy of the Development of Antiretroviral Treatment in Africa (DART) trial. Methods: Six hundred symptomatic antiretroviral‐naive human immunodeficiency virus (HIV)–infected adults (CD4 cell count, 1000 copies/mL, the residual activity of therapy was calculated as the reduction in HIV RNA level, compared with baseline. Results: Overall, HIV RNA levels were lower in the nevirapine group than in the abacavir group at 24 and 48 weeks (P10 copies/mL) than for nevirapine with M184V and nonnucleoside reverse‐transcriptase inhibitor mutations, whether accompanied by TAMs (0.96 log<sub>10</sub> copies/mL) or not (1.18 log<sub>10</sub> copies/mL). Conclusions: There was more extensive genotypic resistance in both treatment groups than is generally seen in resource‐rich settings. However, significant residual activity was observed among patients with virological failure, particularly those receiving zidovudine‐lamivudine plus abacavir.
Citation
The Journal of Infectious Diseases (2010) 201 (1) 106–113 [DOI: 10.1086/648590].