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participating institutions:
Johns Hopkins University AIDS Service, New York State DOH AIDS Institute, The CORE Center, Cook County Hospital



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Patterns of Resistance Mutations Selected by Treatment of HIV Type 1 Infection with Zidovudine, Didanosine, and Nevirapine
[GJ Hanna, et al. JID 2000;181:904]

This is a substudy of ACTG 241, which was a randomized trial comparing AZT/ddI versus AZT/ddI/nevirapine (NVP). The study involved genotypic resistance testing of isolates from 57 patients who had received at least six months of treatment with an incompletely suppressive regimen. The most important observation concerns NVP-selected mutations. The predominant mutations among 30 isolates were 181C (50%), 190A (50%), and 101E (30%). The two mutations that confer clinically significant resistance to efavirenz, 101N and 188L, were found in only 27% of early therapy isolates and 33% of late therapy isolates. With regard to nucleosides, only two of 141 isolates showed the 74V mutation indicating ddI resistance. Most of the isolates showed AZT-resistant mutations, most commonly 41L, 215Y, and 70R.

Comment: This paper shows that patients who have failed NVP-containing combination treatment may still respond to efavirenz, but resistance testing is advocated to support this decision. JGB, 5/3/2000


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