Horizon 1 1 17 ACL : Articles dans des revues avec comité de lecture répertoriées par l'AERES Nucleoside reverse transcriptase inhibitor resistance mutations associated with first-line stavudine-containing antiretroviral therapy : programmatic implications for countries phasing out stavudine Journal of Infectious Diseases S70-S77 HIV-1 drug resistance mutations nucleoside reverse transcriptase inhibitor NRTI stavudine d4T zidovudine AZT tenofovir TDF subtypes 2013 fdi:010060440 ENG Journal of Infectious Diseases 0022-1899 ISI:000319474700005 2 10.1093/infdis/jit114 https://www.documentation.ird.fr/hor/fdi:010060440 https://www.documentation.ird.fr/intranet/publi/2013/07/010060440.pdf 207 Horizon (IRD) The World Health Organization Antiretroviral Treatment Guidelines recommend phasing-out stavudine because of its risk of long-term toxicity. There are two mutational pathways of stavudine resistance with different implications for zidovudine and tenofovir cross-resistance, the primary candidates for replacing stavudine. However, because resistance testing is rarely available in resource-limited settings, it is critical to identify the cross-resistance patterns associated with first-line stavudine failure. We analyzed HIV-1 resistance mutations following first-line stavudine failure from 35 publications comprising 1,825 individuals. We also assessed the influence of concomitant nevirapine vs. efavirenz, therapy duration, and HIV-1 subtype on the proportions of mutations associated with zidovudine vs. tenofovir cross-resistance. Mutations with preferential zidovudine activity, K65R or K70E, occurred in 5.3% of individuals. Mutations with preferential tenofovir activity, >= two thymidine analog mutations (TAMs) or Q151M, occurred in 22% of individuals. Nevirapine increased the risk of TAMs, K65R, and Q151M. Longer therapy increased the risk of TAMs and Q151M but not K65R. Subtype C and CRF01_AE increased the risk of K65R, but only CRF01_AE increased the risk of K65R without Q151M. Regardless of concomitant nevirapine vs. efavirenz, therapy duration, or subtype, tenofovir was more likely than zidovudine to retain antiviral activity following first-line d4T therapy. 052 ; 050 UR174 / UR233 République Centrafricaine / Cameroun / Inde / Malawi / Tchad / Togo / Thaïlande / Afrique du Sud