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Resistance to nonnucleoside reverse transcriptase inhibitors (NNRTIs) increases with the wider use of this class of antiretroviral therapy. The association between adherence and resistance to NNRTI-based regimens is poorly understood. Predictors of virologic failure and resistance according to a baseline evaluation of nonadherence risk factors were determined in a cohort of 71 human immunodeficiency virus (HIV)-infected patients with early virologic response who received an NNRTI-based regimen. During the median follow-up of 29 months, 20 (28%) of 71 patients experienced virologic failure with an NNRTI-based regimen. Virologic failure was associated with repeated drug holidays (48 h of unplanned drug cessation), depression, younger age, and low adherence to therapy during baseline evaluation. Moreover, repeated drug holidays was the only risk factor for developing a major mutation conferring cross-resistance to the NNRTI class (hazard ratio, 22.5; 95% confidence interval, 2.8-180.3; ). Patients' previous adherence to therapy and drugs genetic P ! .0001 barriers, not only the number of pills or doses involved, should be taken into consideration in the decision to simplify highly active antiretroviral therapy. Nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimens-namely those containing efavirenz and nevirapine-are currently much used to simplify HAART. Regimens based on efavirenz are superior to those based on indinavir for achieving undetectable virus load in antiretroviral-naive HIV-infected patients 1. Both drugs demonstrated equal potency in patients previously treated with a protease inhibitor (PI)-based regimen, with long-lasting virologic control 2, 3. Despite this success, resistance to NNRTIs among newly HIV-infected persons increased from 0% in 1996-1997 to 13.
Parienti et al. (Tue,) studied this question.