Objectives: Our aim was to investigate the durability of different initial regimens in patients starting ART with CD4! counts ,200 cells/mm3 and HIV-RNA .5 log10 copies/mL. Methods: This was a retrospective study of HIV-infected patients prospectively followed in the ICONA cohort. Those who started ART with boosted protease inhibitors (bPIs), NNRTIs or integrase strand transfer inhibitors (InSTIs), with CD4! ,200 cells/mm3 and HIV-RNA .5 log10 copies/mL, were included. The primary endpoint was treatment failure (TF), a composite endpoint defined as virological failure (VF, first of two consecutive HIV-RNA .50 copies/mL after 6 months of treatment), discontinuation of class of the anchor drug or death. Independent associations were investigated by Poisson regression analysis in a model including age, gender, mode of HIV transmission, CDC stage, HCV and HBV co-infection, pre-treatment HIV-RNA, CD4! count and CD4!/CD8! ratio, ongoing opportunistic disease, fibrosis FIB-4 index, estimated glomerular filtration rate, haemoglobin, platelets, neutrophils, calendar year of ART initiation, anchor drug class (treatment group) and nucleos(t)ide backbone. Results: A total of 1195 patients fulfilled the inclusion criteria: 696 started ART with a bPI, 315 with an InSTI and 184 with an NNRTI. During 2759 person-years of follow up, 642 patients experienced TF. Starting ART with bPIs [adjusted incidence rate ratio (aIRR) (95% CI) 1.62 (1.29–2.03) versus starting with NNRTIs; P,0.001] and starting ART with InSTIs [aIRR (95% CI) 0.68 (0.48–0.96) versus starting with NNRTIs; P"0.03] were inde- pendently associated with TF. Conclusions: In patients starting ART with ,200 CD4! cells/mm3 and .5 log10 HIV-RNA copies/mL, the durabil- ity of regimens based on InSTIs was longer than that of NNRTI- and bPI-based regimens.
Durability of different initial regimens in HIV-infected patients starting antiretroviral therapy with CD4+ counts <200 cells/mm3 and HIV-RNA >5 log10 copies/mL / N. Gianotti, P. Lorenzini, A. Cozzi-Lepri, A. De Luca, G. Madeddu, L. Sighinolfi, C. Pinnetti, C. Santoro, P. Meraviglia, C. Mussini, A. Antinori, A. D'ARMINIO MONFORTE. - In: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. - ISSN 0305-7453. - 74:9(2019 Jun), pp. 2732-2741. [10.1093/jac/dkz237]
Durability of different initial regimens in HIV-infected patients starting antiretroviral therapy with CD4+ counts <200 cells/mm3 and HIV-RNA >5 log10 copies/mL
A. D'ARMINIO MONFORTEUltimo
2019
Abstract
Objectives: Our aim was to investigate the durability of different initial regimens in patients starting ART with CD4! counts ,200 cells/mm3 and HIV-RNA .5 log10 copies/mL. Methods: This was a retrospective study of HIV-infected patients prospectively followed in the ICONA cohort. Those who started ART with boosted protease inhibitors (bPIs), NNRTIs or integrase strand transfer inhibitors (InSTIs), with CD4! ,200 cells/mm3 and HIV-RNA .5 log10 copies/mL, were included. The primary endpoint was treatment failure (TF), a composite endpoint defined as virological failure (VF, first of two consecutive HIV-RNA .50 copies/mL after 6 months of treatment), discontinuation of class of the anchor drug or death. Independent associations were investigated by Poisson regression analysis in a model including age, gender, mode of HIV transmission, CDC stage, HCV and HBV co-infection, pre-treatment HIV-RNA, CD4! count and CD4!/CD8! ratio, ongoing opportunistic disease, fibrosis FIB-4 index, estimated glomerular filtration rate, haemoglobin, platelets, neutrophils, calendar year of ART initiation, anchor drug class (treatment group) and nucleos(t)ide backbone. Results: A total of 1195 patients fulfilled the inclusion criteria: 696 started ART with a bPI, 315 with an InSTI and 184 with an NNRTI. During 2759 person-years of follow up, 642 patients experienced TF. Starting ART with bPIs [adjusted incidence rate ratio (aIRR) (95% CI) 1.62 (1.29–2.03) versus starting with NNRTIs; P,0.001] and starting ART with InSTIs [aIRR (95% CI) 0.68 (0.48–0.96) versus starting with NNRTIs; P"0.03] were inde- pendently associated with TF. Conclusions: In patients starting ART with ,200 CD4! cells/mm3 and .5 log10 HIV-RNA copies/mL, the durabil- ity of regimens based on InSTIs was longer than that of NNRTI- and bPI-based regimens.File | Dimensione | Formato | |
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