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Contemporary initial antiretroviral therapy (ART) regimens are associated with high rates of viral suppression. Treatment failure on initial regimens can be caused by drug resistance or nonadherence, either of which may influence response to second-line therapy. In a retrospective cohort analysis conducted in South Africa, investigators used stored specimens from patients with treatment failure on first-line ART to determine the contributions of resistance and nonadherence to failure or success with second-line regimens.
From among 417 patients switching to second-line ART with viral loads >400 copies/mL, 122 had samples for genotyping, drug-concentration measurement, or both (73 had both, 42 had genotyping only, and 7 had drug-concentration…