@article{PAR00008371,
  title = {{R}esistance patterns selected by nevirapine vs. efavirenz in hiv-infected patients failing first-line antiretroviral treatment: a bayesian analysis},
  author = {{N}go-{G}iang-{H}uong, {N}icole and {J}ourdain, {G}onzague and {A}mzal, {B}illy and {S}ang-{A}-{G}ad, {P}. and {L}ertkoonalak, {R}. and {E}iamsirikit, {N}. and {T}ansuphasawasdikul, {S}. and {B}uranawanitchakorn, {Y}. and {Y}utthakasemsunt, {N}. and {M}ekviwattanawong, {S}. and {M}c{I}ntosh, {K}. and {L}allemant, {M}arc},
  editor = {},
  language = {{ENG}},
  abstract = {{B}ackground: {WHO} recommends starting therapy with a non-nucleoside reverse transcriptase inhibitor ({NNRTI}) and two nucleoside reverse transcriptase inhibitors ({NRTI}s), i.e. nevirapine or efavirenz, with lamivudine or emtricitabine, plus zidovudine or tenofovir. {F}ew studies have compared resistance patterns induced by efavirenz and nevirapine in patients infected with the {CRF}01_{AE} {S}outheast {A}sian {HIV}-subtype. {W}e compared patterns of {NNRTI}-and {NRTI}-associated mutations in {T}hai adults failing first-line nevirapine-and efavirenz-based combinations, using {B}ayesian statistics to optimize use of data. {M}ethods and {F}indings: {I}n a treatment cohort of {HIV}-infected adults on {NNRTI}-based regimens, 119 experienced virologic failure (<500 copies/m{L}), with resistance mutations detected by consensus sequencing. {M}utations were analyzed in relation to demographic, clinical, and laboratory variables at time of genotyping. {T}he {G}eno2{P}heno system was used to evaluate second-line drug options. {E}ighty-nine subjects were on nevirapine and 30 on efavirenz. {T}he {NRTI} backbone consisted of lamivudine or emtricitabine plus either zidovudine (37), stavudine (65), or tenofovir (19). {T}he {K}103{N} mutation was detected in 83% of patients on efavirenz vs. 28% on nevirapine, whereas {Y}181{C} was detected in 56% on nevirapine vs. 20% efavirenz. {M}184{V} was more common with nevirapine (87%) than efavirenz (63%). {N}evirapine favored {TAM}-2 resistance pathways whereas efavirenz selected both {TAM}-2 and {TAM}-1 pathways. {E}mergence of {TAM}-2 mutations increased with the duration of virologic replication ({OR} 1.25-1.87 per month increment). {I}n zidovudine-containing regimens, the overall risk of resistance across all drugs was lower with nevirapine than with efavirenz, whereas in tenofovir-containing regimen the opposite was true. {C}onclusions: {TAM}-2 was the major {NRTI} resistance pathway for {CRF}01_ {AE}, particularly with nevirapine; it appeared late after virological failure. {I}n patients who failed, there appeared to be more second-line drug options when zidovudine was combined with nevirapine or tenofovir with efavirenz than with alternative combinations.},
  keywords = {{THAILANDE}},
  booktitle = {},
  journal = {{P}los {O}ne},
  volume = {6},
  numero = {11},
  pages = {e27427},
  ISSN = {1932-6203},
  year = {2011},
  DOI = {10.1371/journal.pone.0027427},
  URL = {https://www.documentation.ird.fr/hor/{PAR}00008371},
}