The TAF arm had significantly improved renal and bone safety parameters: less proteinuria and less change in hip and spine BMD, consistent with results from a similarly designed study of the elvitegravir/C/F/TAF STR. This D/C/F/TAF STR offers a promising option for initial HIV treatment, with the high barrier to resistance of darunavir, and the potential for improved long-term renal and bone safety with TAF.

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ObjectivesTo estimate the prevalence of transmitted antiretroviral (ARV) drug resistance, and to assess whether resistance testing influences first-line ARV regimen selection. MethodsData on patients' characteristics were collected through questionnaires. ARV drug resistance was tested by genotypic methods and defined by Quest-Stanford classification rule. Physicians reported the intended and actual treatments and the factors considered in treatment selection. ResultsTwo hundred and twenty-eight patients were included. The prevalence of ARV drug resistance was 12.1%, with 9.8% for non-nucleoside reverse transcriptase inhibitors (NNRTIs), 4.5% for nucleoside reverse transcriptase inhibitors and 1.8% for protease inhibitors (PIs). Pill burdens, dosing frequency and physicians' experience with regimens were the major factors considered in treatment selection. The intended and actual treatment differed for 73 and 44% of the patients with and without ARV drug resistance, respectively [odds ratio (95% confidence interval, CI) 5 3.6 (1.5-9.0), P 5 0.006]. NNRTI-based regimens were intended for 10 patients with resistance to NNRTIs; these patients were prescribed PI-based regimens after genotypic testing. ConclusionsTransmitted ARV drug resistance was detected in 12.1% of treatment-naïve patients, with resistance to NNRTIs the most common. Resistance-testing results played a partial role in first-line treatment selection. However, resistance to NNRTIs pre-empted NNRTI use.Keywords: drug resistance testing, first-line treatment, HIV, transmitted drug resistance IntroductionThe use of highly active antiretroviral therapy has made it possible to prolong the life expectancy and reduce the incidence of opportunistic infection in persons with HIV infection or AIDS [1][2][3][4]. Current recommended initial regimens employ two nucleoside reverse transcriptase inhibitors (NRTIs) plus either a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI). Unfortunately, under drug-selective pressure, resistance to these drugs may develop, primarily as a result of mutations in viral reverse transcriptase and protease genes. It has been estimated that approximately 40-80% of chronically HIV-infected, treatment-experienced patients with incomplete virus suppression developed resistance to antiretroviral (ARV) therapy [5], leading to poorer survival and opportunities for transmitted ARV drug resistance [6].Transmitted resistance to ARV drugs can persist for years [7][8][9], and hence has implications for treatment strategies. According to the International AIDS Society-USA and the US Department of Health and Human Services guidelines, resistance testing is recommended for patients with acute or recent infection (o6-12 months), and is recommended or should be considered for treatment-naïve patients with chronic infection (1 year or longer) [12,13]. Recently, the use of HIV susceptibility testing was shown to be associated with enhanced survival -even after adjusting for stages of HIV disease, demographics and ag...

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