HIV Drug Resistance in Adults Receiving Early vs. Delayed Antiretroviral Therapy: HPTN 052

作者：J.E. Gallant, J. Makhema, R. Panchia, Micaela Morgado, C. Wallis, S. Badal-Faesen, S. Chariyalertsak, E.A. Wilson, J.J. Eron, J.G. Hakim, N. Kumarasamy, S. Saravanan, L. Hovind, M.C. Hosseinipour, J. Kumwenda, S.V. Godbole, J.H. Pilotto, J.M. Fogel, Maria A. Papathanasopoulos, P.J. Palumbo, T. Gamble, S. Hart, B. Grinsztejn, S. Tripathy, M.S. Cohen, E. Piwowar-Manning, Y.Q. Chen, S.H. Eshleman, M. McCauley, S.E. Hudelson, V. Akelo, B.R. Santos · 发表于：UNC Libraries · 年份：2020 · DOI：10.17615/1m2y-j442 · 研究领域：HIV/AIDS drug development and treatment、HIV/AIDS Research and Interventions、HIV-related health complications and treatments

Introduction: We evaluated HIV drug resistance in adults who received early vs. delayed antiretroviral therapy (ART) in a multinational trial [HIV Prevention Trials Network (HPTN) 052, enrollment 2005-2010]. In HPTN 052, 1763 index participants were randomized to start ART at a CD4 cell count of 350-550 cells/mm 3 (early ART arm) or <250 cells/mm 3 (delayed ART arm). In May 2011, interim study results showed benefit of early ART, and all participants were offered ART regardless of CD4 cell count; the study ended in 2015. Methods: Virologic failure was defined as 2 consecutive viral loads >1000 copies/mL >24 weeks after ART initiation. Drug resistance testing was performed for pretreatment (baseline) and failure samples from participants with virologic failure. Results: HIV genotyping results were obtained for 211/249 participants (128 early ART arm and 83 delayed ART arm) with virologic failure. Drug resistance was detected in 4.7% of participants at baseline; 35.5% had new resistance at failure. In univariate analysis, the frequency of new resistance at failure was lower among participants in the early ART arm (compared with delayed ART arm, P = 0.06; compared with delayed ART arm with ART initiation before May 2011, P = 0.032). In multivariate analysis, higher baseline viral load (P = 0.0008) and ART regimen (efavirenz/lamivudine/zidovudine compared with other regimens, P = 0.024) were independently associated with higher risk of new resistance at failure. Conclusions: In H...