Failure of stavudine-lamivudine combination therapy in antiretroviral-naive patients with AZT-Like HIV-1 resistance mutations

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Abstract
To analyze the clinical relevance of AZT resistance mutations in AZT‐naive patients, 56 HIV‐1 seropositive patients treated for 18 months with stavudine/lamivudine (27 patients) or AZT/lamivudine (29 patients) were studied. AZT‐like resistance mutations were found in 13 out of 29 (44%) patients treated with AZT/lamivudine and in 11 out of 27 (40%) patients treated with stavudine/lamivudine. No stavudine or multi‐drug resistance mutations were detected. After 26 months of treatment more than 60% of patients showed a virological failure. Among 10 patients failing treatment with stavudine/lamivudine, 9 had AZT‐like resistance mutations. The phenotypic test, performed on HIV‐1 strains isolated from six of these nine patients, showed a resistance to AZT in five isolates and to stavudine in two isolates. The genotypic pattern of the latter two isolates showed the combined mutations M184V plus R211K and L214F. AZT‐like resistance mutations in AZT‐naive patients seem to correlate with a virological failure during long‐term stavudine therapy. J. Med. Virol. 65:631–636, 2001.

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