Adverse events to antiretrovirals in the Swiss HIV Cohort Study: effect on mortality and treatment modification.

Details

Serval ID
serval:BIB_7CEF0A310DCA
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Adverse events to antiretrovirals in the Swiss HIV Cohort Study: effect on mortality and treatment modification.
Journal
Antiviral Therapy
Author(s)
Keiser O., Fellay J., Opravil M., Hirsch H.H., Hirschel B., Bernasconi E., Vernazza P.L., Rickenbach M., Telenti A., Furrer H.
ISSN
1359-6535
Publication state
Published
Issued date
2007
Peer-reviewed
Oui
Volume
12
Number
8
Pages
1157-1164
Language
english
Abstract
BACKGROUND: Antiretroviral therapy (ART) decreases morbidity and mortality in HIV-infected patients but is associated with considerable adverse events (AEs). METHODS: We examined the effect of AEs to ART on mortality, treatment modifications and drop-out in the Swiss HIV Cohort Study. A cross-sectional evaluation of prevalence of 13 clinical and 11 laboratory parameters was performed in 1999 in 1,078 patients on ART. AEs were defined as abnormalities probably or certainly related to ART. A score including the number and severity of AEs was defined. The subsequent progression to death, drop-out and treatment modification due to intolerance were evaluated according to the baseline AE score and characteristics of individual AEs. RESULTS: Of the 1,078 patients, laboratory AEs were reported in 23% and clinical AEs in 45%. During a median follow up of 5.9 years, laboratory AEs were associated with higher mortality with an adjusted hazard ratio (HR) of 1.3 (95% confidence interval [CI] 1.2-1.5; P < 0.001) per score point. For clinical AEs no significant association with increased mortality was found. In contrast, an increasing score for clinical AEs (HR 1.11,95% CI 1.04-1.18; P = 0.002), but not for laboratory AEs (HR 1.07, 95% CI 0.97-1.17; P = 0.17), was associated with antiretroviral treatment modification. AEs were not associated with a higher drop-out rate. CONCLUSIONS: The burden of laboratory AEs to antiretroviral drugs is associated with a higher mortality. Physicians seem to change treatments to relieve clinical symptoms, while accepting laboratory AEs. Minimizing laboratory drug toxicity seems warranted and its influence on survival should be further evaluated.
Keywords
Adult, Anti-Retroviral Agents/adverse effects, Anti-Retroviral Agents/therapeutic use, Antiretroviral Therapy, Highly Active, Cohort Studies, Cross-Sectional Studies, Female, HIV, HIV Infections/drug therapy, HIV Infections/mortality, Humans, Male, Middle Aged, Survival Analysis, Switzerland, Treatment Outcome, Withholding Treatment
Pubmed
Web of science
Create date
24/09/2009 17:12
Last modification date
20/08/2019 14:38
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