Cross-resistance among nonnucleoside reverse transcriptase inhibitors limits recycling efavirenz after nevirapine failure

Andrea Antinori, Enrico Girardi, Andrea De Luca, Carlo F. Perno, Mauro Zaccarelli, Antonella Cingolani, Federica Forbici, Maria G. Rizzo, Maria P. Trotta, Simona Di Giambenedetto, Pasquale Narciso, Adriana Ammassari

Research output: Contribution to journalArticlepeer-review


Heterogeneity in genotype mutations associated with resistance of HIV to nonnucleoside reverse transcriptase inhibitors (NNRTIs) should allow identification of patients failing nevirapine (NVP) who might benefit from efavirenz (EFV)-containing salvage regimens. To establish the feasibility of recycling EFV after failure of NVP-containing regimens genotypic data on 103 NVP-failed patients were analyzed to evaluate the prevalence of EFV resistance-conferring mutations. A clinically significant resistance to EFV was found in 50 of 103 (58%) of NVP-failed subjects. Furthermore, the 3-month virological response to salvage regimens containing EFV was assessed in patients previously treated with NVP and carrying single mutations conferring resistance to this drug. A proportion of HIV RNA less than 500 copies/ml at 3 months was obtained only in 2 of 12 (17%) of EFV-treated subjects compared with 35 of 67 (52%) of those without NNRTI mutations (OR, 0.18; 95% CI, 0.03-0.79). The median HIV-1 RNA decrease after 3 months was -0.63 log 10 among patients carrying single NNRTI-associated mutations compared with -1.32 log 10 among those without any NNRTI mutations. No virological response was observed in six patients harboring a single Y181C/I mutation. On the basis of the present data, sequential use of NNRTIs should be avoided in the management of treatment failure.

Original languageEnglish
Pages (from-to)835-838
Number of pages4
JournalAIDS Research and Human Retroviruses
Issue number12
Publication statusPublished - 2002

ASJC Scopus subject areas

  • Immunology
  • Virology


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