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High levels of multiclass resistance have been reported at first treatment failure in resource-poor settings that lack viral-load testing, and prolonged viremia before the recognition of treatment failure has been thought to be responsible.
Researchers studied the resistance patterns of HIV in 115 patients in South Africa who experienced virologic failure while receiving their first potent antiretroviral therapy (ART) regimen. Patients were recruited from two regional referral centers that, unlike most resource-poor settings, had viral-load testing available. More than 97% of the patients were infected with clade C virus. At the time of virologic failure, patients had been on ART (91% on NNRTI-based regimens) for a median of 11 months, but t…