Lower prevalence of drug resistance mutations at first-line virological failure to first-line therapy with atripla vs. tenofovir+ XXXX / @entity16332 +efavirenz administered on a multiple tablet therapy.

@entity1 @entity16332 @entity14492 @entity12046 @entity15832 @entity19368 @entity19899 @entity15834
BACKGROUND: Fixed-dose combination antiretroviral therapy administered as a single-tablet regimen (STR) may improve virologic suppression rates. The effect of STRs on development of resistance when virologic failure occurs on STRs is not known. OBJECTIVES: To compare the rate of emergent drug resistance mutations (DRMs) on first-line therapy with coformulated @entity19368 ( @entity12046 )/ @entity15832 ( @entity15834 )/efavirenz ( @entity14492 ) as an STR versus @entity12046 , @entity16332 ( @entity16332 ) or @entity15834 , and @entity14492 given as non-STR. METHODS: @entity1 from eight cohorts and four randomized clinical trials who received first-line antiretroviral therapy with Atripla (STR group) or with @entity12046 + @entity15834 / @entity16332 + @entity14492 (non-STR group) were eligible if a genotypic resistance test was available immediately after the first episode of viral failure. The DRM list from the 2013 version of IAS-USA was used. RESULTS: One hundred and eighty-six @entity1 were included in the final analysis, 122 (65.6%) from eight cohorts and 64 (34.1%) from four randomized clinical trials. The overall proportion of @entity1 with at least one DRM at viral failure was 67.7%, including 53.4% (31 of 58) in the STR group vs. 74.2% (95 of 128) in the non-STR group (P=0.005). Among @entity1 exclusively from cohorts, at least one DRM was detected in 53.4% (31 of 58) in the STR group vs. 78.1% (50 of 64) in the non-STR group (P=0.004). DRMs for individual drugs were: @entity12046 , 15.5 vs. 16.4% (P=0.87); @entity16332 / @entity15834 , 31 vs. 35.2% (P=0.58); and NNRTI, 51.7 vs. 65.6% (P=0.07). The proportion of @entity1 with an @entity19899 /I among the 128 @entity1 who received @entity15834 was 32.8 vs. 36.2% among the 58 treated with @entity16332 (P=0.65). CONCLUSIONS: Compared to @entity1 receiving the STR-Atripla, those receiving the same components individually in a non-STR regimen have a statistically significantly increased risk of selecting for DRMs associated with their drugs on failure.
