Evidence map›Paper›PMID 24633208›Full record

Trial reportThe Journal of antimicrobial chemotherapy2014

Phenotypic and genotypic analyses to guide selection of reverse transcriptase inhibitors in second-line HIV therapy following extended virological failure in Uganda.

R L Goodall, D T Dunn, T Pattery, A van Cauwenberge, P Nkurunziza, P Awio, N Ndembi, P Munderi, C Kityo, C F Gilks and 3 more

Open access · hybridAbstract readRandomized Controlled Trial
In one paragraph

Trial report in The Journal of antimicrobial chemotherapy, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 2 papers, 1 of them a synthesis that pooled it.

0numbers the graph read from it
0cells of the map it votes in
2citing papers in PubMed, 1 pooled it
0.4field-weighted citation impact, top 37% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

2 citing papers in PubMed, 1 synthesis or guideline pooled it, 3 citations in OpenAlex.

  1. Pooled it
  2. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors at 6 institutions in 4 countries.

R L GoodallMRC Clinical Trials Unit, London, UK r.goodall@ctu.mrc.ac.uk.
D T DunnMRC Clinical Trials Unit, London, UK.
T PatteryVirco BVBA, Beerse, Belgium.
A van CauwenbergeVirco BVBA, Beerse, Belgium.
P NkurunzizaMRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
P AwioJoint Clinical Research Centre, Kampala, Uganda.
N NdembiInstitute of Human Virology, Abuja, Nigeria.
P MunderiMRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
C KityoJoint Clinical Research Centre, Kampala, Uganda.
C F GilksSchool of Population Health, University of Queensland, Brisbane, Australia.
P KaleebuMRC/UVRI Uganda Research Unit on AIDS, Entebbe, Uganda.
D PillayDepartment of Infection, University College London, London, UK Centres for Infection, Public Health England, Colindale, UK.
DART Virology Group and Trial Teams
Uganda Virus Research Institute · UGThe University of Queensland · AUPublic Health England · GBJoint Clinical Research Centre · UGMRC Clinical Trials Unit at UCL · GBInstitute of Human Virology · NG

Funding

Medical Research Council G0600344Medical Research Council MC_U950080931Medical Research Council MC_U950080938
6 · The paper itself

Abstract

objectivesWe investigated phenotypic and genotypic resistance after 2 years of first-line therapy with two HIV treatment regimens in the absence of virological monitoring.

methodsNORA [Nevirapine OR Abacavir study, a sub-study of the Development of AntiRetroviral Therapy in Africa (DART) trial] randomized 600 symptomatic HIV-infected Ugandan adults (CD4 cell count <200 cells/mm(3)) to receive zidovudine/lamivudine plus abacavir (cABC arm) or nevirapine (cNVP arm). All virological tests were performed retrospectively, including resistance tests on week 96 plasma samples with HIV RNA levels ≥1000 copies/mL. Phenotypic resistance was expressed as fold-change in IC(50) (FC) relative to wild-type virus.

resultsHIV-1 RNA viral load ≥1000 copies/mL at week 96 was seen in 58/204 (28.4%) cABC participants and 21/159 (13.2%) cNVP participants. Resistance results were available in 35 cABC and 17 cNVP participants; 31 (89%) cABC and 16 (94%) cNVP isolates had a week 96 FC below the biological cut-off for tenofovir (2.2). In the cNVP arm, 16/17 participants had resistance mutations synonymous with high-level resistance to nevirapine and efavirenz; FC values for etravirine were above the biological cut-off in 9 (53%) isolates. In multivariate regression models, K65R, Y115F and the presence of thymidine analogue-associated mutations were associated with increased susceptibility to etravirine in the cABC arm.

conclusionsOur data support the use of tenofovir following failure of a first-line zidovudine-containing regimen and shed further light on non-nucleoside reverse transcriptase inhibitor hypersusceptibility.

Indexed as

Drug Resistance, ViralAdenineAdultAnti-HIV AgentsAntiretroviral Therapy, Highly ActiveHIV-1HIV InfectionsHIV Reverse TranscriptaseHumansInhibitory Concentration 50Microbial Sensitivity TestsOrganophosphonatesTenofovirUgandaZidovudineAdenineAnti-HIV AgentsHIV Reverse TranscriptaseOrganophosphonatesreverse transcriptase, Human immunodeficiency virus 1TenofovirZidovudineAfricahypersusceptibilityresistance

Identifiers

PMID24633208
PMCPMC4054985
OpenAlexW2132007207

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.