UNIGE document Scientific Article
previous document  unige:7372  next document
add to browser collection
Title

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

Authors
Kaufmann, G. R.
Khanna, Nina
Weber, Rainer
Furrer, Hansjakob
Cavassini, Matthias
Ledergerber, Bruno
Vernazza, Pietro
show hidden authors show all authors [1 - 12]
Published in Antiviral Therapy. 2004, vol. 9, no. 2, p. 263-274
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 AdultAntiretroviral Therapy, Highly ActiveCohort StudiesDrug Administration ScheduleFemaleHIV Infections/ drug therapy/virologyHIV-1/ drug effects/physiologyHumansMaleMiddle AgedProspective StudiesRNA, Viral/ bloodTreatment OutcomeViral Load
Identifiers
PMID: 15134189
Full text
Structures
Citation
(ISO format)
KAUFMANN, G. R. et al. Long-term virological response to multiple sequential regimens of highly active antiretroviral therapy for HIV infection. In: Antiviral Therapy, 2004, vol. 9, n° 2, p. 263-274. https://archive-ouverte.unige.ch/unige:7372

259 hits

0 download

Update

Deposited on : 2010-06-21

Export document
Format :
Citation style :