Prevalence of etravirine (ETR)-RAMs at NNRTI failure and predictors of resistance to ETR in a large Italian resistance database (ARCA)

The prevalence of drug resistance associated with the failure of nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and the predictors of resistance to Etravirine (ETR) were assessed in 2854 subjects: 39 < 18 (paediatric) and 2815 ≥ 18 (adult) years old. These subjects failed to...

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Bibliographic Details
Published in:Clinical microbiology and infection 2013-10, Vol.19 (10), p.E443-E446
Main Authors: Rusconi, S., Adorni, F., Bruzzone, B., Di Biagio, A., Meini, G., Callegaro, A., Punzi, G., Boeri, E., Pecorari, M., Monno, L., Gianotti, N., Butini, L., Galli, L., Polilli, E., Galli, M.
Format: Article
Language:English
Subjects:
Adult
Algorithms
Antiretroviral drugs
Child
Drug resistance
Drug Resistance, Viral
etravirine
Female
Genotype
HIV
HIV Infections - drug therapy
HIV Infections - epidemiology
HIV Infections - virology
HIV-1
HIV-1 - genetics
HIV-1 - isolation & purification
Human immunodeficiency virus
Humans
Italy - epidemiology
Male
Multivariate Analysis
Prevalence
Pyridazines - therapeutic use
Retrospective Studies
Reverse Transcriptase Inhibitors - therapeutic use
Treatment Failure
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Summary:The prevalence of drug resistance associated with the failure of nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens and the predictors of resistance to Etravirine (ETR) were assessed in 2854 subjects: 39 < 18 (paediatric) and 2815 ≥ 18 (adult) years old. These subjects failed to respond to their current NNRTI treatment, were three-class experienced and had been exposed to NNRTI for ≥ 3 months. A total of 1827 adult (64.9%) and 32 paediatric subjects (82.1%) harboured the virus with at least one ETR mutation. V179I, Y181C and G190A were the most frequent mutations in both groups. A significantly increased risk of ETR resistance with all three algorithms (Monogram (MGR) >3, Tibotec (TBT) >2 and enhanced MGR (ENH) ≥ 4) emerged in the paediatric population. Multivariate analysis revealed an increased risk of developing TBT >2 for NNRTI exposure, ENH ≥ 4 for NNRTI and EFV exposure in paediatric subjects; NVP exposure and higher (≥ 3.5 log10) HIV-RNA values for all three algorithms in adult subjects, whereas CD4 ≥ 200/μL appeared to be protective. The risk of being ETR resistant was more than doubled for paediatric vs. adult subjects, probably due to a more extensive use of NNRTI and an incomplete virological control.
ISSN:1198-743X
1469-0691
DOI:10.1111/1469-0691.12229