Does short-term virologic failure translate to clinical events in antiretroviral-naïve patients initiating antiretroviral therapy in clinical practice? The Antiretroviral Therapy Cohort Collaboration (ART-CC)
Academic Article
Publication Date:
2008
abstract:
OBJECTIVE:
To determine whether differences in short-term virologic failure among commonly used antiretroviral therapy (ART) regimens translate to differences in clinical events in antiretroviral-naïve patients initiating ART.
DESIGN:
Observational cohort study of patients initiating ART between January 2000 and December 2005.
SETTING:
The Antiretroviral Therapy Cohort Collaboration (ART-CC) is a collaboration of 15 HIV cohort studies from Canada, Europe, and the United States.
STUDY PARTICIPANTS:
A total of 13 546 antiretroviral-naïve HIV-positive patients initiating ART with efavirenz, nevirapine, lopinavir/ritonavir, nelfinavir, or abacavir as third drugs in combination with a zidovudine and lamivudine nucleoside reverse transcriptase inhibitor backbone.
MAIN OUTCOME MEASURES:
Short-term (24-week) virologic failure (>500 copies/ml) and clinical events within 2 years of ART initiation (incident AIDS-defining event, death, and a composite measure of these two outcomes).
RESULTS:
Compared with efavirenz as initial third drug, short-term virologic failure was more common with all other third drugs evaluated; nevirapine (adjusted odds ratio = 1.87, 95% confidence interval (CI) = 1.58-2.22), lopinavir/ritonavir (1.32, 95% CI = 1.12-1.57), nelfinavir (3.20, 95% CI = 2.74-3.74), and abacavir (2.13, 95% CI = 1.82-2.50). However, the rate of clinical events within 2 years of ART initiation appeared higher only with nevirapine (adjusted hazard ratio for composite outcome measure 1.27, 95% CI = 1.04-1.56) and abacavir (1.22, 95% CI = 1.00-1.48).
CONCLUSION:
Among antiretroviral-naïve patients initiating therapy, between-ART regimen, differences in short-term virologic failure do not necessarily translate to differences in clinical outcomes. Our results should be interpreted with caution because of the possibility of residual confounding by indication.
To determine whether differences in short-term virologic failure among commonly used antiretroviral therapy (ART) regimens translate to differences in clinical events in antiretroviral-naïve patients initiating ART.
DESIGN:
Observational cohort study of patients initiating ART between January 2000 and December 2005.
SETTING:
The Antiretroviral Therapy Cohort Collaboration (ART-CC) is a collaboration of 15 HIV cohort studies from Canada, Europe, and the United States.
STUDY PARTICIPANTS:
A total of 13 546 antiretroviral-naïve HIV-positive patients initiating ART with efavirenz, nevirapine, lopinavir/ritonavir, nelfinavir, or abacavir as third drugs in combination with a zidovudine and lamivudine nucleoside reverse transcriptase inhibitor backbone.
MAIN OUTCOME MEASURES:
Short-term (24-week) virologic failure (>500 copies/ml) and clinical events within 2 years of ART initiation (incident AIDS-defining event, death, and a composite measure of these two outcomes).
RESULTS:
Compared with efavirenz as initial third drug, short-term virologic failure was more common with all other third drugs evaluated; nevirapine (adjusted odds ratio = 1.87, 95% confidence interval (CI) = 1.58-2.22), lopinavir/ritonavir (1.32, 95% CI = 1.12-1.57), nelfinavir (3.20, 95% CI = 2.74-3.74), and abacavir (2.13, 95% CI = 1.82-2.50). However, the rate of clinical events within 2 years of ART initiation appeared higher only with nevirapine (adjusted hazard ratio for composite outcome measure 1.27, 95% CI = 1.04-1.56) and abacavir (1.22, 95% CI = 1.00-1.48).
CONCLUSION:
Among antiretroviral-naïve patients initiating therapy, between-ART regimen, differences in short-term virologic failure do not necessarily translate to differences in clinical outcomes. Our results should be interpreted with caution because of the possibility of residual confounding by indication.
Iris type:
1.1 Articolo in rivista
Keywords:
AIDS; AIDS-related opportunistic infections; Antiretroviral therapy; Cohort analysis; Highly active; HIV; Mortality; Viral load; Adolescent; Adult; Anti-Retroviral Agents; Disease-Free Survival; Drug Interactions; Drug Resistance, Viral; Drug Therapy, Combination; Epidemiologic Methods; Female; HIV Infections; Humans; Male; Middle Aged; Odds Ratio; RNA, Viral; Reverse Transcriptase Inhibitors; Treatment Outcome; Viral Load; Young Adult; HIV-1; Immunology and Allergy; Immunology; Infectious Diseases
List of contributors:
Casabona, Jordi; Chêne, Geneviève; Del Amo, Julia; Fätkenheuer, Gerd; Guest, Jodie; Kitahata, Mari; Ledergerber, Bruno; Mocroft, Amanda; Reiss, Peter; Mugavero, Michael J.; May, Margaret; Harris, Ross; Saag, Michael S.; Costagliola, Dominique; Egger, Matthias; Phillips, Andrew; Günthard, Huldrych F.; Dabis, François; Hogg, Robert; De Wolf, Frank; Gill, M. John; Justice, Amy; Monforte, Antonella D'Arminio; Lampe, Fiona; Miró, Jose M.; Staszewski, Schlomo; Sterne, Jonathan A. C.; Dewolf, Frank; Filice, Gaetano
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