HIV-1 amino acid changes among participants with virologic failure: Associations with first-line efavirenz or atazanavir plus ritonavir and disease status

Abstract

Background Although specific human immunodeficiency virus type 1 (HIV-1) drug resistance mutations are well studied, little is known about cumulative amino acid changes, or how regimen and participant characteristics influence these changes.Methods In the AIDS Clinical Trials Group randomized study A5202 of treatment-naive HIV-infected participants, cumulative HIV-1 amino acid changes from pretreatment to virologic failure were evaluated in protease and reverse transcriptase (RT) gene sequences.Results Among 265 participants with virologic failure, those assigned atazanavir plus ritonavir (ATV/r) did not have significantly more protease changes compared with those assigned efavirenz (EFV) (P ≥. 13). In contrast, participants with virologic failure assigned EFV had more RT changes, including and excluding known resistance codons (P