Treatment modification in human immunodeficiency virus-infected individuals starting combination antiretroviral therapy between 2005 and 2008.

Details

Serval ID
serval:BIB_FFDD9D2AEA04
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Treatment modification in human immunodeficiency virus-infected individuals starting combination antiretroviral therapy between 2005 and 2008.
Journal
Archives of Internal Medicine
Author(s)
Elzi L., Marzolini C., Furrer H., Ledergerber B., Cavassini M., Hirschel B., Vernazza P., Bernasconi E., Weber R., Battegay M.
Working group(s)
Swiss HIV Cohort Study
Contributor(s)
Battegay M., Bernasconi E., Böni J., Bucher HC., Bürgisser P., Calmy A., Cattacin S., Cavassini M., Dubs R., Egger M., Elzi L., Fischer M., Flepp M., Fontana A., Francioli P., Furrer H., Fux CA., Gorgievski M., Günthard H., Hirsch HH., Hirschel B., Hösli I., Kahlert C., Kaiser L., Karrer U., Kind C., Klimkait T., Ledergerber B., Martinetti G., Martinez de Tejada B., Müller N., Nadal D., Opravil M., Paccaud F., Pantaleo G., Rauch A., Regenass S., Rickenbach M., Rudin C., Schmid P., Schultze D., Schüpbach J., Speck R., Taffe P., Tarr P., Telenti A., Trkola A., Vernazza P., Weber R.
ISSN
1538-3679 (Electronic)
ISSN-L
0003-9926
Publication state
Published
Issued date
2010
Volume
170
Number
1
Pages
57-65
Language
english
Notes
Publication types: Journal Article ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Abstract
BACKGROUND: Adverse effects of combination antiretroviral therapy (CART) commonly result in treatment modification and poor adherence.
METHODS: We investigated predictors of toxicity-related treatment modification during the first year of CART in 1318 antiretroviral-naive human immunodeficiency virus (HIV)-infected individuals from the Swiss HIV Cohort Study who began treatment between January 1, 2005, and June 30, 2008.
RESULTS: The total rate of treatment modification was 41.5 (95% confidence interval [CI], 37.6-45.8) per 100 person-years. Of these, switches or discontinuations because of drug toxicity occurred at a rate of 22.4 (95% CI, 19.5-25.6) per 100 person-years. The most frequent toxic effects were gastrointestinal tract intolerance (28.9%), hypersensitivity (18.3%), central nervous system adverse events (17.3%), and hepatic events (11.5%). In the multivariate analysis, combined zidovudine and lamivudine (hazard ratio [HR], 2.71 [95% CI, 1.95-3.83]; P < .001), nevirapine (1.95 [1.01-3.81]; P = .050), comedication for an opportunistic infection (2.24 [1.19-4.21]; P = .01), advanced age (1.21 [1.03-1.40] per 10-year increase; P = .02), female sex (1.68 [1.14-2.48]; P = .009), nonwhite ethnicity (1.71 [1.18-2.47]; P = .005), higher baseline CD4 cell count (1.19 [1.10-1.28] per 100/microL increase; P < .001), and HIV-RNA of more than 5.0 log(10) copies/mL (1.47 [1.10-1.97]; P = .009) were associated with higher rates of treatment modification. Almost 90% of individuals with treatment-limiting toxic effects were switched to a new regimen, and 85% achieved virologic suppression to less than 50 copies/mL at 12 months compared with 87% of those continuing CART (P = .56).
CONCLUSIONS: Drug toxicity remains a frequent reason for treatment modification; however, it does not affect treatment success. Close monitoring and management of adverse effects and drug-drug interactions are crucial for the durability of CART.
Keywords
AIDS-Related Opportunistic Infections/drug therapy, AIDS-Related Opportunistic Infections/epidemiology, Adenine/administration & dosage, Adenine/adverse effects, Adult, Anti-HIV Agents/administration & dosage, Anti-HIV Agents/adverse effects, Benzoxazines/administration & dosage, Benzoxazines/adverse effects, Deoxycytidine/administration & dosage, Deoxycytidine/adverse effects, Dideoxynucleosides/administration & dosage, Dideoxynucleosides/adverse effects, Drug Therapy, Combination, Female, HIV Infections/drug therapy, HIV Infections/epidemiology, Humans, Lamivudine/administration & dosage, Lamivudine/adverse effects, Lopinavir, Male, Middle Aged, Nevirapine/administration & dosage, Nevirapine/adverse effects, Oligopeptides/administration & dosage, Oligopeptides/adverse effects, Organophosphonates/administration & dosage, Organophosphonates/adverse effects, Proportional Hazards Models, Prospective Studies, Pyridines/administration & dosage, Pyridines/adverse effects, Pyrimidinones/administration & dosage, Pyrimidinones/adverse effects, Risk Factors, Switzerland/epidemiology, Zidovudine/administration & dosage, Zidovudine/adverse effects
Pubmed
Web of science
Open Access
Yes
Create date
26/01/2010 15:32
Last modification date
20/08/2019 16:30
Usage data