Long-term virological response to multiple sequential regimens of highly active antiretroviral therapy for HIV infection

Details

Serval ID
serval:BIB_E779951187D8
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Long-term virological response to multiple sequential regimens of highly active antiretroviral therapy for HIV infection
Journal
Antiviral Therapy
Author(s)
Kaufmann  G. R., Khanna  N., Weber  R., Perrin  L., Furrer  H., Cavassini  M., Ledergerber  B., Vernazza  P., Bernasconi  E., Rickenbach  M., Hirschel  B., Battegay  M.
ISSN
1359-6535 (Print)
Publication state
Published
Issued date
04/2004
Volume
9
Number
2
Pages
263-74
Notes
Clinical Trial
Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't --- Old month value: Apr
Abstract
OBJECTIVE: Information about the virological response to sequential highly active antiretroviral therapy (HAART) for HIV infection is limited. The virological response to four consecutive therapies was evaluated in the Swiss HIV Cohort. DESIGN: Retrospective analysis in an observational cohort. METHODS: 1140 individuals receiving uninterrupted HAART for 4.8 +/- 0.6 years were included. The virological response was classified as success (<400 copies/ml), low-level (LF: 400-5000 copies/ml) or high-level failure (HF: >5000 copies/ml). Potential determinants of the virological response, including patient demographics, treatment history and virological response to previous HAART regimens were analysed using survival and logistic regression analyses. RESULTS: 40.1% failed virologically on the first (22.0% LF; 18.1% HF), 35.1% on the second (14.2% LF; 20.9% HF), 34.2% on the third (9.9% LF; 24.3% HF) and 32.7% on the fourth HAART regimen (9% LF; 23.7% HF). Nucleoside pre-treatment (OR: 2.34; 95% CI: 1.67-3.29) and low baseline CD4 T-cell count (OR: 0.79/100 cells rise; 95% CI: 0.72-0.88) increased the risk of HF on the first HAART. Virological failure on HAART with HIV-1 RNA levels exceeding 1000 copies/ml predicted a poor virological response to subsequent HAART regimens. A switch from a protease inhibitor- to a non-nucleoside reverse transcriptase inhibitor-containing regimen significantly reduced the risk of HF. Multiple switches of HAART did not affect the recovery of CD4 T lymphocytes. CONCLUSION: Multiple sequential HAART regimens do not per se reduce the likelihood of long-term virological suppression and immunological recovery. However, early virological failure increases significantly the risk of subsequent unfavourable virological responses. The choice of a potent initial antiretroviral drug regimen is therefore critical.
Keywords
Adult *Antiretroviral Therapy, Highly Active Cohort Studies Drug Administration Schedule Female HIV Infections/*drug therapy/virology HIV-1/*drug effects/physiology Humans Male Middle Aged Prospective Studies RNA, Viral/*blood Treatment Outcome *Viral Load
Pubmed
Web of science
Create date
29/01/2008 8:52
Last modification date
20/08/2019 16:10
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