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When virologic failure occurs in patients receiving contemporary first-line antiretroviral regimens, inadequate adherence is usually blamed, especially if standard baseline HIV genotypic testing did not reveal the presence of drug-resistant virus. An analysis from the FIRST study, however, indicates that some failures are a consequence of preexisting resistance that is not detectable by standard genotyping.
The FIRST study involved nearly 1400 treatment-naive patients who were randomized to receive two NRTIs plus a PI, an NNRTI, or both. At baseline, standard resistance genotyping was performed on plasma samples from 491 randomly selected participants. Ultradeep sequencing was later performed on the 258 stored samples that had adequate viral…