Effectiveness of second-line antiretroviral therapy: the impact of drug switches
Carregando...
Data
Título da Revista
ISSN da Revista
Título de Volume
Editor
Universidade Federal de Minas Gerais
Descrição
Tipo
Artigo de evento
Título alternativo
Primeiro orientador
Membros da banca
Resumo
Background: Including antiretroviral drug switches
as a measure of ART failure could be more suitable
than conventional measures to evaluate health outcomes in ‘real-world’ settings.
Objectives: Evaluate the effectiveness of second-line
ART in HIV-infected adults participating in a historical cohort study, comparing two scenarios by using
different parameters to characterize ART failure.
Methods: This is part of a historical cohort of HIV-infected adults who initiated ART from 2001 to 2005,
and were followed up for a maximum of five years,
conducted in three HIV/AIDS centers in Belo
Horizonte, Brazil. Follow-up information included
data from 2001 to 2010. All patients switched from
first-line to second-line ART were included. Secondline ART effectiveness was measured as the timeto-ART failure. Failure was defined simulating to
scenarios: (1) Clinical, immunological and virological
failure (scenario 1); or scenario 1 plus ART switches
(scenario 2). Descriptive analysis, Kaplan-Meier
curves, log-rank test, and Cox proportional hazards
model were performed.
Results: A total of 119 patients were eligible; most
had protease inhibitor (PI)-based regimens prescribed
as second-line. The incidence of failure was different
for the two scenarios (29.4% vs. 54.6% for scenario
1 and 2, respectively; p= 0.00). The main identifiers
of failure were increase in viral load (31.1%) for scenario 1 and ART switches (42.8%) for scenario 2. Median duration on second-line ART was 36.8 vs. 19.8
months for scenario 1 and 2, respectively. In the Cox
analysis of scenario 2, increased risk was found for patients given PI-based second-line regimens
(HR = 2.26; 95% CI: 1.09–3.17).
Conclusions: There is a high incidence of ART failure
associated with PI-based regimens when ART
switches are considered as an indicator of failure. This
demonstrates the impact of ART switches in
representing lack of ART effectiveness.
Abstract
Assunto
HIV, AIDS
Palavras-chave
HIV, AIDS, Terapia antirretroviral, Estudos de coorte
Citação
Curso
Endereço externo
https://onlinelibrary.wiley.com/doi/full/10.1002/pds.4275