Early ART Initiation May Reduce Drug Resistance at Time of Virologic Failure

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The frequency of new drug resistance at virologic failure was lower among participants in the early ART group.
The frequency of new drug resistance at virologic failure was lower among participants in the early ART group.

For patients with HIV, early antiretroviral therapy (ART) may reduce the frequency of new drug resistance at virologic failure, according to results published online in the Journal of Acquired Immune Deficiency Syndromes.

The results indicated that the main factor associated with reduced drug resistance for patients who had early ART was a lower baseline viral load.

The researchers included participants from a multinational trial, HPTN 052 (ClinicalTrials.gov identifier: NCT00074581). One thousand seven hundred sixty-three study participants infected with HIV were randomly assigned to start ART at a CD4 cell count of 350 to 550 cells/mm3 (early ART group) or <250 cells/mm3 (delayed ART group).

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The researchers defined virologic failure as 2 consecutive viral loads >1000 copies/mL >24 weeks after ART initiation. Participants were tested for drug resistance at baseline and then at virologic failure, if applicable.

The researchers obtained HIV genotyping results for 211 of the 249 participants who experienced virologic failure (128 from the early ART group, 83 from the delayed ART group). Drug resistance was detected in 4.7% of participants at baseline, whereas 35.5% had a new drug resistance at time of virologic failure.

Participants in the early ART group had a lower frequency of new drug resistance at virologic failure compared with participants in the delayed ART group (P =.06).

The researchers found that both higher baseline viral load (P =.0008) and ART regimen (efavirenz/lamivudine/zidovudine compared with other regimens, P =.024) were independently associated with a higher risk of new drug resistance at virologic failure.

The researchers concluded that the frequency of newly detected drug resistance at time of virologic feature is reduced in adults with HIV who are initiated on ART at earlier times.

Disclosures

Carole Wallis, PhD, served as a consultant for Celera for development of software updates related to the HIV drug resistance algorithm used with the ViroSeq HIV-1 Genotyping System. Joseph J. Eron, MD, receives honoraria for advisory board membership from Bristol-Myers Squibb, Gilead Sciences, Janssen Therapeutics, Merck & Co., and ViiV Healthcare and research support from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Therapeutics, Merck & Co., Sangamo BioSciences, and ViiV Healthcare through contracts to the University of North Carolina. Joel E. Gallant, MD, MPH, receives honoraria for advisory board membership from Bristol-Myers Squibb, Gilead Sciences, Theratechnologies, Merck & Co., and ViiV Healthcare. Dr Gallant's organization receives research support from AbbVie, Bristol-Myers Squibb, Gilead Sciences, Janssen Therapeutics, Merck & Co., Sangamo BioSciences, and ViiV Healthcare. Mina C. Hosseinipour, MD, MPH, has received honoraria for advisory board membership from ViiV Healthcare. Myron S. Cohen, MD, receives honoraria for advisory board membership from Janssen Global Services, Roche Molecular Systems, and Merck Research. Susan H. Eshleman, MD, PhD, has collaborated with investigators from Abbott Diagnostics on research studies.

Reference

Palumbo PJ, Fogel JM, Hudelson SE, et al. HIV drug resistance in adults receiving early versus delayed antiretroviral therapy: HPTN 052 [published online December 28, 2017]. J Acquir Immune Defic Syndr. doi:10.1097/QAI.0000000000001623

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