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About the Authors:
Dieter Hoffmann
* E-mail: [email protected]
Affiliation: Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Albert D. Garcia
Affiliation: Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
P. Richard Harrigan
Affiliation: British Columbia Centre for Excellence in HIV/AIDS, Vancouver, British Columbia, Canada
Ian C. D. Johnston
Affiliation: Miltenyi Biotec, Bergisch Gladbach, Germany
Tadashi Nakasone
Affiliation: AIDS Research Center, National Institute of Infectious Diseases, Tokyo, Japan
J. Gerardo García-Lerma
Affiliation: Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Walid Heneine
Affiliation: Laboratory Branch, Division of HIV/AIDS Prevention, National Center for HIV, STD, and TB Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia, United States of America
Introduction
Antiretroviral therapy has significantly improved life expectancy and quality of life in persons living with HIV [1]. Currently there are 24 antiretroviral drugs approved by the US Food and Drug Administration (FDA) for the treatment of HIV-1-infected persons, including 11 reverse transcriptase (RT) inhibitors, 10 protease inhibitors, 1 fusion inhibitor, 1 entry inhibitor, and 1 integrase inhibitor. The selection of a combination regimen that maximally suppresses virus replication is critical for treatment success, since persistent virus replication due to suboptimal therapy may result in the selection of viruses carrying drug-resistance mutations. The emergence of drug-resistant viruses can be one of the most important factors leading to therapy failure [2]. Accumulating data from various retrospective and prospective studies support the use of drug-resistance testing in many clinical situations, and several agencies and expert panels such as the IAS-USA Panel [3], the EuroGuidelines Group for HIV Resistance [4], and the U.S. Department of Health and Human Services (http://www.aidsinfo.nih.gov/ContentFiles/AdultandAdolescentGL.pdf) recommend drug-resistance testing for the management of antiretroviral therapy.
NNRTI-based ART regimens containing efavirenz (EFV) or nevirapine (NVP) are frequently used in first regimens worldwide. These regimens typically include a nucleoside RT inhibitor backbone containing either lamivudine (3TC) or the closely related emtricitabine (FTC). Resistance to 3TC/FTC is primarily associated with mutations at position 184 of...