Does less frequent routine monitoring of patients on a stable, fully suppressed cART regimen lead to an increased risk of treatment failure?
Details
Serval ID
serval:BIB_E0181F1523D0
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Does less frequent routine monitoring of patients on a stable, fully suppressed cART regimen lead to an increased risk of treatment failure?
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., Machala L., Rozsypal H., Sedlacek D., Nielsen J., Lundgren J., Benfield T., Kirk O., Gerstoft J., Katzenstein T., Hansen AB., Skinhøj P., Pedersen C., Zilmer K., Katlama C., Viard JP., Girard PM., Saint-Marc T., Vanhems P., Pradier C., Dabis F., Dietrich M., Manegold C., van Lunzen J., Stellbrink KJ., Staszewski S., Bickel M., Goebel FD., Fätkenheuer D., Rockstroh J., Schmidt R., Kosmidis J., Gargalianos P., Sambatakou H., Perdios J., Panos G., Filandras A., Karabatsaki A., Banhegyi D., Mulcahy F., Yust I., Turner D., Burke M., Pollack S., Hassoun G., Sthoeger Z., Maayan S., Vella S., Chiesi A., Arici C., Pristerá A., Mazzotta F., Gabbuti A., Esposito R., Bedini A., Chirianni A., Montesarchio E., Vullo V., Santopadre P., Narciso P., Antinori A., Franci P., Zaccarelli M., Lazzarin A., Finazzi R., D'Arminio Monforte A., Ridolfo AL., Viksna L., 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., Matez F., Duiculescu D., Streinu-Cercel A., Vinogradova E., Vinogradova D., Mokrás M., Staneková D., González-Lahoz J., Barreiro P., García-Benayas T., Martin-Carbonero L., Soriano V., Clotet B., Jou A., Conejero J., Tural C., Gatell JM., Miró JM., Blaxhult A., Karlsson A., Pehrson P., Ledergerber B., Weber R., Francioli P., Telenti A., Hirschel B., Soravia-Dunand V., Furrer H., Chentsova N., Barton S., Johnson AM., Mercey D., PhillipsQ A., Johnson MA., Mocroft A., Murphy M., Weber J., Scullard G., Fisher M., Brettle R., Clotet B., Antunes F., Clotet B., Duiculescu D., Gatell J., Gazzard B., Horban A., Karlsson A., Katlama C., Ledergerber B., D'Arminio Montforte A., Phillips A., Rakhmanova A., Reiss P., Rockstroh J., Lundgren J., Gjørup I., Kirk I., Mocroft A., Friis-Møller N., Cozzi-Lepri A., Bannister W., Ellefson M., Borch A., Podlekareva D., Holkmann Olsen C., Kjaer J., Peters L., Reekie J.
ISSN
1473-5571 (Electronic)
ISSN-L
0269-9370
Publication state
Published
Issued date
11/2008
Peer-reviewed
Oui
Volume
22
Number
17
Pages
2381-2390
Language
english
Notes
Publication types: Journal Article ; Multicenter Study ; Research Support, Non-U.S. Gov't
Publication Status: ppublish
Publication Status: ppublish
Abstract
OBJECTIVE: To investigate whether HIV-infected patients on a stable and fully suppressive combination antiretroviral therapy (cART) regimen could safely be monitored less often than the current recommendations of every 3 months.
DESIGN: Two thousand two hundred and forty patients from the EuroSIDA study who maintained a stable and fully suppressed cART regimen for 1 year were included in the analysis.
METHODS: Risk of treatment failure, defined by viral rebound, fall in CD4 cell count, development of new AIDS-defining illness, serious opportunistic infection or death, in the 12 months following a year of a stable and fully suppressed regimen was assessed.
RESULTS: One hundred thirty-one (6%) patients experienced treatment failure in the 12 months following a year of stable therapy, viral rebound occurred in 99 (4.6%) patients. After 3, 6 and 12 months, patients had a 0.3% [95% confidence interval (CI) 0.1-0.5], 2.2% (95% CI 1.6-2.8) and 6.0% (95% CI 5.0-7.0) risk of treatment failure, respectively. Patients who spent more than 80% of their time on cART with fully suppressed viraemia prior to baseline had a 38% reduced risk of treatment failure, hazard ratio 0.62 (95% CI 0.42-0.90, P = 0.01).
CONCLUSION: Patients who have responded well to cART and are on a well tolerated and durably fully suppressive cART regimen have a low chance of experiencing treatment failure in the next 3-6 months. Therefore, in this subgroup of otherwise healthy patients, it maybe reasonable to extend visit intervals to 6 months, with cost and time savings to both the treating clinics and the patients.
DESIGN: Two thousand two hundred and forty patients from the EuroSIDA study who maintained a stable and fully suppressed cART regimen for 1 year were included in the analysis.
METHODS: Risk of treatment failure, defined by viral rebound, fall in CD4 cell count, development of new AIDS-defining illness, serious opportunistic infection or death, in the 12 months following a year of a stable and fully suppressed regimen was assessed.
RESULTS: One hundred thirty-one (6%) patients experienced treatment failure in the 12 months following a year of stable therapy, viral rebound occurred in 99 (4.6%) patients. After 3, 6 and 12 months, patients had a 0.3% [95% confidence interval (CI) 0.1-0.5], 2.2% (95% CI 1.6-2.8) and 6.0% (95% CI 5.0-7.0) risk of treatment failure, respectively. Patients who spent more than 80% of their time on cART with fully suppressed viraemia prior to baseline had a 38% reduced risk of treatment failure, hazard ratio 0.62 (95% CI 0.42-0.90, P = 0.01).
CONCLUSION: Patients who have responded well to cART and are on a well tolerated and durably fully suppressive cART regimen have a low chance of experiencing treatment failure in the next 3-6 months. Therefore, in this subgroup of otherwise healthy patients, it maybe reasonable to extend visit intervals to 6 months, with cost and time savings to both the treating clinics and the patients.
Keywords
AIDS-Related Opportunistic Infections/drug therapy, AIDS-Related Opportunistic Infections/economics, Adult, Anti-HIV Agents/therapeutic use, Anti-Retroviral Agents/therapeutic use, CD4 Lymphocyte Count, Clinical Protocols, Drug Administration Schedule, Female, HIV Infections/drug therapy, HIV Infections/economics, HIV-1/drug effects, Humans, Male, Middle Aged, Patient Compliance, Prospective Studies, Treatment Failure, Viral Load
Pubmed
Web of science
Create date
05/03/2009 17:15
Last modification date
20/08/2019 17:04
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