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 independently associated with TF. Conclusions: In patients starting ART with <200 CD4+ cells/mm3 and >5 log10 HIV-RNA copies/mL, the durability 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 / Gianotti N.; Lorenzini P.; Cozzi-Lepri A.; De Luca A.; Madeddu G.; Sighinolfi L.; Pinnetti C.; Santoro C.; Meraviglia P.; Mussini C.; Antinori A.; D'Arminio Monforte A.; Andreoni M.; Angarano G.; Castelli F.; Cauda R.; Di Perri G.; Galli M.; Iardino R.; Ippolito G.; Lazzarin A.; Perno C.F.; Von Schloesser F.; Viale P.; Castagna A.; Ceccherini-Silberstein F.; Girardi E.; Lo Caputo S.; Puoti M.; Ammassari A.; Balotta C.; Bandera A.; Bonfanti P.; Bonora S.; Borderi M.; Calcagno A.; Calza L.; Capobianchi M.R.; Cingolani A.; Cinque P.; Di Biagio A.; Gori A.; Guaraldi G.; Lapadula G.; Lichtner M.; Maggiolo F.; Marchetti G.; Marcotullio S.; Monno L.; Nozza S.; Quiros Roldan E.; Rossotti R.; Rusconi S.; Saracino A.; Zaccarelli M.; Fanti I.; Rodano A.; Shanyinde M.; Tavelli A.; Carletti F.; Carrara S.; Di Caro A.; Graziano S.; Petrone F.; Prota G.; Quartu S.; Truffa S.; Giacometti A.; Costantini A.; Valeriani C.; Suardi C.; Donati V.; Verucchi G.; Quiros E.; Minardi C.; Quirino T.; Abeli C.; Manconi P.E.; Piano P.; Cacopardo B.; Celesia B.; Vecchiet J.; Falasca K.; Segala D.; Mazzotta F.; Vichi F.; Cassola G.; Viscoli C.; Alessandrini A.; Bobbio N.; Mazzarello G.; Mastroianni C.; Belvisi V.; Caramma I.; Chiodera A.; Rizzardini G.; Ridolfo A.L.; Piolini R.; Carenzi L.; Moioli M.C.; Tincati C.; Puzzolante C.; Abrescia N.; Chirianni A.; Borgia G.; Di Martino F.; Maddaloni L.; Gentile I.; Orlando R.; Baldelli F.; Francisci D.; Parruti G.; Ursini T.; Magnani G.; Ursitti M.A.; Vullo V.; Cristaudo A.; Baldin G.; Cicalini S.; Gallo L.; Nicastri E.; Acinapura R.; Capozzi M.; Libertone R.; Savinelli S.; Latini A.; Cecchetto M.; Viviani F.; Mura M.S.; Rossetti B.; Caramello P.; C Orofino G.; Sciandra M.; Bassetti M.; Londero A.; Pellizzer G.; Manfrin V.. - In: JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY. - ISSN 0305-7453. - STAMPA. - 74:9(2019), 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
Calza L.
Membro del Collaboration Group
;Verucchi G.
Membro del Collaboration Group
;
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 independently associated with TF. Conclusions: In patients starting ART with <200 CD4+ cells/mm3 and >5 log10 HIV-RNA copies/mL, the durability of regimens based on InSTIs was longer than that of NNRTI- and bPI-based regimens.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
