Detection of HIV drug resistance during antiretroviral treatment and clinical progression in a large European cohort study.
Details
Serval ID
serval:BIB_BF6D271026B2
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Detection of HIV drug resistance during antiretroviral treatment and clinical progression in a large European cohort study.
Journal
Aids
Working group(s)
EuroSIDA Study Group
Contributor(s)
Losso M., Duran A., Vetter N., Karpov I., Vassilenko A., Clumeck N., De Wit S., Poll B., Colebunders R., Kostov K., Begovac J., Ristola M., Machala L., Rozsypal H., Sedlacek D., Nielsen J., Lundgren J., Benfield T., Kirk O., Gerstoft J., Katzenstein T., Hansen AB., Skinhøj P., Pedersen C., Oestergaard L., Zilmer K., Smidt J., Katlama C., Viard JP., Girard PM., Livrozet JM., Vanhems P., Pradier C., Dabis F., Rockstroh J., Schmidt R., van Lunzen J., Degen O., Stellbrink HJ., Staszewski S., Bogner J., Fätkenheuer G., Kosmidis J., Gargalianos P., Xylomenos G., Perdios J., Panos G., Filandras A., Karabatsaki E., Sambattakou H., Banhegyi D., Mulcahy F., Yust Y., Turner D., Burke M., Pollack S., Hassoun G., Maayan S., Chiesi A., Esposito R., Mazeu I., Mussini C., Arici C., Pristera R., Mazzotta F., Gabbuti A., Vullo V., Lichtner M., Chirianni A., Montesarchio E., Gargiulo M., Antonucci G., Iacomi F., Narciso P., Vlassi C., Zaccarelli M., Lazzarin A., Finazzi R., Galli M., Ridolfo A., Monforte£££A d'Arminio£££ Ad. , Rozentale B., Aldins P., Chaplinskas S., Hemmer R., Staub T., Reiss P., Bruun J., Maeland A., Ormaasen V., Knysz B., Gasiorowski J., Horban A., Prokopowicz D., Wiercinska-Drapalo A., Boron-Kaczmarska A., Pynka M., Beniowski M., Mularska E., Trocha H., Antunes F., Valadas E., Mansinho K., Maltez F., Duiculescu D., Babes V., Rakhmanova A., Vinogradova E., Buzunova S., Jevtovic D., Mokrás M., Staneková D., González-Lahoz J., Soriano V., Martin-Carbonero L., Labarga P., Clotet B., Jou A., Conejero J., Tural C., Gatell JM., Miró JM., Domingo P., Gutierrez M., Mateo G., Sambeat MA., Karlsson A., Persson PO., Flamholc L., Ledergerber B., Weber R., Francioli P., Cavassini M., Hirschel B., Boffi E., Furrer H., Battegay M., Elzi L., Kravchenko E., Chentsova N., Barton S., Johnson AM., Mercey D., Phillips A., Johnson MA., Mocroft A., Murphy M., Weber J., Scullard G., Fisher M., Brettle R., Clotet B., Antunes F., Clotet B., Duiculescu J., Gatell J., Gazzard B., Horban A., Karlsson A., Katlama C., Ledergerber B., Monforte£££A d'Arminio£££ Ad. , Phillips A., Rakhmanova A., Reiss P., Rockstroh J., Lundgren J., Kirk O., Mocroft A., Friis-Møller N., Cozzi-Lepri A., Bannister W., Ellefson M., Borch A., Podlevkareva D., Kjaer J., Peters L., Reekie J.
ISSN
1473-5571 (Electronic)
ISSN-L
0269-9370
Publication state
Published
Issued date
10/2008
Peer-reviewed
Oui
Volume
22
Number
16
Pages
2187-2198
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
OBJECTIVE(S): To investigate the relationship between detection of HIV drug resistance by 2 years from starting antiretroviral therapy and the subsequent risk of progression to AIDS and death.
DESIGN: Virological failure was defined as experiencing two consecutive viral loads of more than 400 copies/ml in the time window between 0.5 and 2 years from starting antiretroviral therapy (baseline). Patients were grouped according to evidence of virological failure and whether there was detection of the International AIDS Society resistance mutations to one, two or three drug classes in the time window.
METHODS: Standard survival analysis using Kaplan-Meier curves and Cox proportional hazards regression model with time-fixed covariates defined at baseline was employed.
RESULTS: We studied 8229 patients in EuroSIDA who started antiretroviral therapy and who had at least 2 years of clinical follow-up. We observed 829 AIDS events and 571 deaths during 38,814 person-years of follow-up resulting in an overall incidence of new AIDS and death of 3.6 per 100 person-years of follow-up [95% confidence interval (CI):3.4-3.8]. By 96 months from baseline, the proportion of patients with a new AIDS diagnosis or death was 20.3% (95% CI:17.7-22.9) in patients with no evidence of virological failure and 53% (39.3-66.7) in those with virological failure and mutations to three drug classes (P = 0.0001). An almost two-fold difference in risk was confirmed in the multivariable analysis (adjusted relative hazard = 1.8, 95% CI:1.2-2.7, P = 0.005).
CONCLUSION: Although this study shows an association between the detection of resistance at failure and risk of clinical progression, further research is needed to clarify whether resistance reflects poor adherence or directly increases the risk of clinical events via exhaustion of drug options.
DESIGN: Virological failure was defined as experiencing two consecutive viral loads of more than 400 copies/ml in the time window between 0.5 and 2 years from starting antiretroviral therapy (baseline). Patients were grouped according to evidence of virological failure and whether there was detection of the International AIDS Society resistance mutations to one, two or three drug classes in the time window.
METHODS: Standard survival analysis using Kaplan-Meier curves and Cox proportional hazards regression model with time-fixed covariates defined at baseline was employed.
RESULTS: We studied 8229 patients in EuroSIDA who started antiretroviral therapy and who had at least 2 years of clinical follow-up. We observed 829 AIDS events and 571 deaths during 38,814 person-years of follow-up resulting in an overall incidence of new AIDS and death of 3.6 per 100 person-years of follow-up [95% confidence interval (CI):3.4-3.8]. By 96 months from baseline, the proportion of patients with a new AIDS diagnosis or death was 20.3% (95% CI:17.7-22.9) in patients with no evidence of virological failure and 53% (39.3-66.7) in those with virological failure and mutations to three drug classes (P = 0.0001). An almost two-fold difference in risk was confirmed in the multivariable analysis (adjusted relative hazard = 1.8, 95% CI:1.2-2.7, P = 0.005).
CONCLUSION: Although this study shows an association between the detection of resistance at failure and risk of clinical progression, further research is needed to clarify whether resistance reflects poor adherence or directly increases the risk of clinical events via exhaustion of drug options.
Keywords
Acquired Immunodeficiency Syndrome/epidemiology, Adolescent, Adult, Aged, Aged, 80 and over, Anti-HIV Agents/therapeutic use, Antiretroviral Therapy, Highly Active, Disease Progression, Drug Resistance, Multiple, Viral, Drug Resistance, Viral, Epidemiologic Methods, Europe/epidemiology, Female, HIV Infections/drug therapy, HIV Infections/mortality, HIV-1/drug effects, HIV-1/genetics, Humans, Male, Middle Aged, Mutation, Prognosis, Treatment Failure, Viral Load, Young Adult
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Web of science
Create date
05/03/2009 17:47
Last modification date
20/08/2019 16:33
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