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Predictors of optimal viral suppression in patients switched to abacavir, lamivudine, and zidovudine: the Swiss HIV Cohort Study

Authors
Wolbers, Marcel
Opravil, Milos
von Wyl, Viktor
Furrer, Hansjakob
Cavassini, Matthias
Vernazza, Pietro
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Published in AIDS. 2007, vol. 21, no. 16, p. 2201-2207
Abstract OBJECTIVE: To investigate predictors of continued HIV RNA viral load suppression in individuals switched to abacavir (ABC), lamivudine (3TC) and zidovudine (ZDV) after successful previous treatment with a protease inhibitor or non-nucleoside reverse transcriptase inhibitor-based combination antiretroviral therapy. DESIGN AND METHODS: An observational cohort study, which included individuals in the Swiss HIV Cohort Study switching to ABC/3TC/ZDV following successful suppression of viral load. The primary endpoint was time to treatment failure defined as the first of the following events: two consecutiveviral load measurements > 400 copies/ml under ABC/3TC/ZDV, one viral load measurement > 400 copies/ml and subsequent discontinuation of ABC/3TC/ZDV within 3 months, AIDS or death. RESULTS: We included 495 individuals; 47 experienced treatment failure in 1459 person-years of follow-up [rate = 3.22 events/100 person-years; 95% confidence interval (95% CI), 2.30-4.14]. Of all failures, 62% occurred in the first year after switching to ABC/3TC/ZDV. In a Cox regression analysis, treatment failure was independently associated with earlier exposure to nucleoside reverse transcriptase inhibitor (NRTI) mono or dual therapy [hazard ratio (HR), 8.02; 95% CI, 4.19-15.35) and low CD4 cell count at the time of the switch (HR, 0.66; 95% CI, 0.51-0.87 by +100 cells/microl up to 500 cells/microl). In patients without earlier exposure to mono or dual therapy, AIDS prior to switch to simplified maintenance therapy was an additional risk factor. CONCLUSIONS: The failure rate was low in patients with suppressed viral load and switch to ABC/3TC/ZDV treatment. Patients with earlier exposure to mono or dual NRTI therapy, low CD4 cell count at time of switch, or AIDS are at increased risk of treatment failure, limiting the use of ABC/3TC/ZDV in these patient groups.
Keywords AdultAntiretroviral Therapy, Highly ActiveCD4 Lymphocyte CountCohort StudiesDideoxynucleosides/ therapeutic useDrug Therapy, CombinationFemaleGenes, MDRHIV Infections/ drug therapy/immunology/virologyHIV Protease Inhibitors/therapeutic useHIV-1/geneticsHumansLamivudine/ therapeutic useMaleMiddle AgedMutationPrognosisProportional Hazards ModelsRNA, Viral/bloodReverse Transcriptase Inhibitors/ therapeutic useSwitzerlandTreatment FailureViral LoadZidovudine/ therapeutic use
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PMID: 18090047
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WOLBERS, Marcel et al. Predictors of optimal viral suppression in patients switched to abacavir, lamivudine, and zidovudine: the Swiss HIV Cohort Study. In: AIDS, 2007, vol. 21, n° 16, p. 2201-2207. https://archive-ouverte.unige.ch/unige:7691

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Deposited on : 2010-06-21

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