Emergence of HIV-1 Drug Resistance in Previously Untreated Patients Initiating Combination Antiretroviral TreatmentA Comparison of Different Regimen Types

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Abstract
Current guidelines recommend the initiation of combination antiretroviral treatment (cART) against human immunodeficiency virus 1 (HIV-1) with 2 nucleoside reverse transcriptase inhibitors (NRTIs) and a nonnucleoside reverse transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r).1 These different drug classes vary considerably in the number of mutations required to confer resistance and in the degree of cross-resistance to drugs of the same class. Selection of a single mutation leads to the emergence of high-level resistance against NNRTIs, and resistance usually emerges quickly if treatment failure occurs.2,3 In contrast, virological failure with boosted PIs is associated with a reduced risk of selection of drug resistance mutations.4

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