Only those participants with documented integrase inhibitor resistance were excluded, and 24% of participants had resistance to NRTIs
DTG/3TC was found to be non-inferior to triple therapy, although one individual who developed virologic failure on the dual regimen subsequently developed NRTI
and integrase resistance mutations (M184V and R263R/K) (23).
Memoranda of Agreement have been signed by NRTI
with Cornell University, USA; University of California, Berkeley; MIIT, Moscow and St.
For several years, the first-line regimens usually included two nucleoside analog reverse transcriptase inhibitors (NRTIs
) and a non-nucleoside reverse transcriptase inhibitor (NNRTI) or a protease inhibitor (PI).
Recommended third-line ART regimens in the WHO 2016 guidelines  are: (i) darunavir/ritonavir (DRV/r) plus dolutegravir (DTG) (or raltegravir (RAL)) with or without one to two nucleoside reverse transcriptase inhibitors (NRTIs
); (ii) DRV/r plus two NRTIs
with or without one NNRTI; or (iii) RAL (or DTG) plus two NRTIs
, depending on the preceding first- and second-line ART regimens.
were as follows; tenofovir disoproxil fumarate/emtricitabine (88.9%), zidovudin/lamivudine (9.5%) and abacavir/lamivudine (1.6%).
Observed RAMs found in the study Number Number Percentage of samples of samples analyzed with RAMS Major NRTI
27 1 3.7% Major NNRTI 27 11 40.7% Minor PI 29 8 27.6% NRTI--nucleoside reverse transcriptase inhibitors; NNRTI--non-nucleoside reverse transcriptase inhibitors; PI--protease inhibitors; RAM--resistance associated mutations.
Since the introduction of triple combined therapy, the NNRTI class has been recommended as first-line treatment, combined with two NRTIs
, with EFV being the NNRTI of choice.
Reduced susceptibility was not associated with sex, age, race, CD4 cell count, HIV RNA level, or NRTI
, NNRTI, PI genotypic mutations but INSTI experience was significantly associated (p < .01).
There were no statistically significant differences based on the type of cART (PI or NRTI
based) (p 0.082).
(%) p-value Sex, no., and % Women 2,422 (67) Men 1,260 (33) WHO HIV disease stage Stage I/II Women 363 (19) 0.064 Men 224 (22) Stage III Women 987 (61) Men 453 (53) Stage IV Women 331 (21) Men 223 (26) Missing data 1,101 (30) Female regimens NVP-3TC-D4T/AZT/TDF 1,219 (49) 0.077 EFV-3TC-D4T/AZT/TDF 692 (30) Triple NRTI
90 (3) PI-based 122 (4) Unknown 211 (10) Other 88 (5) Male regimens NVP-3TC-D4T/AZT/TDF 548 (42) EFV-3TC-D4T/AZT/TDF 430 (36) Triple NRTI
48 (3) PI-based 84 (6) Unknown 110 (9) Other 40 (3) Swaziland * (N = 2,510) Median Characteristic No.
Among the NRTI
drugs were biovir (ATC), composed by the combination of 300mg zidovudine (AZT) and 150mg lamivudine (3TC), 400 mg enteric didanosine (DDI400), 300mg tenofovir (TDF) and 150mg lamivudine (3TC).
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World Health Organization (WHO) guidelines for first-line antiretroviral therapy in resource-limited settings recommend that treatment should be based on nucleoside/nucleotide reverse transcriptase inhibitor (NRTI
) backbones of AZT and 3TC (lamivudine, Epivir), or tenofovir (Viread) and 3TC.
In the region, non-suppressive regimens such as mono/dual nucleoside reverse transcriptase inhibitor (NRTI
) therapies have historically been used.