Impact of previous virological treatment failures and adherence on the outcome of antiretroviral therapy in 2007

Ballif, Marie; Ledergerber, Bruno; Battegay, Manuel; Cavassini, Matthias; Bernasconi, Enos; Schmid, Patrick; Hirschel, Bernard; Furrer, Hansjakob; Rickenbach, Martin; Opravil, Milos; Weber, Rainer

doi:10.1371/journal.pone.0008275

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Title		Impact of previous virological treatment failures and adherence on the outcome of antiretroviral therapy in 2007
Authors		Ballif, Marie Ledergerber, Bruno Battegay, Manuel Cavassini, Matthias Bernasconi, Enos Schmid, Patrick Hirschel, Bernard Furrer, Hansjakob Rickenbach, Martin Opravil, Milos Weber, Rainer show all authors [1 - 11]
Published in		PLOS ONE. 2009, vol. 4, no. 12, p. e8275
Abstract		BACKGROUND: Combination antiretroviral treatment (cART) has been very successful, especially among selected patients in clinical trials. The aim of this study was to describe outcomes of cART on the population level in a large national cohort. METHODS: Characteristics of participants of the Swiss HIV Cohort Study on stable cART at two semiannual visits in 2007 were analyzed with respect to era of treatment initiation, number of previous virologically failed regimens and self reported adherence. Starting ART in the mono/dual era before HIV-1 RNA assays became available was counted as one failed regimen. Logistic regression was used to identify risk factors for virological failure between the two consecutive visits. RESULTS: Of 4541 patients 31.2% and 68.8% had initiated therapy in the mono/dual and cART era, respectively, and been on treatment for a median of 11.7 vs. 5.7 years. At visit 1 in 2007, the mean number of previous failed regimens was 3.2 vs. 0.5 and the viral load was undetectable (<50 copies/ml) in 84.6% vs. 89.1% of the participants, respectively. Adjusted odds ratios of a detectable viral load at visit 2 for participants from the mono/dual era with a history of 2 and 3, 4, >4 previous failures compared to 1 were 0.9 (95% CI 0.4-1.7), 0.8 (0.4-1.6), 1.6 (0.8-3.2), 3.3 (1.7-6.6) respectively, and 2.3 (1.1-4.8) for >2 missed cART doses during the last month, compared to perfect adherence. From the cART era, odds ratios with a history of 1, 2 and >2 previous failures compared to none were 1.8 (95% CI 1.3-2.5), 2.8 (1.7-4.5) and 7.8 (4.5-13.5), respectively, and 2.8 (1.6-4.8) for >2 missed cART doses during the last month, compared to perfect adherence. CONCLUSIONS: A higher number of previous virologically failed regimens, and imperfect adherence to therapy were independent predictors of imminent virological failure.
Keywords		Adult — Anti-Retroviral Agents/pharmacology/ therapeutic use — Cohort Studies — Drug Therapy, Combination — Female — Follow-Up Studies — HIV Infections/ drug therapy — HIV-1/drug effects — Humans — Male — Medication Adherence — Middle Aged — Patient Selection — RNA, Viral/genetics — Switzerland — Treatment Failure — Viral Load/drug effects
Identifiers		DOI: 10.1371/journal.pone.0008275 PMID: 20011544
Full text		Article - Free access Other version: http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2789943/pdf/pone.0008275.pdf
Structures		Faculté de médecine / Section de médecine fondamentale / Département de médecine génétique et développement
Citation (ISO format)		BALLIF, Marie et al. Impact of previous virological treatment failures and adherence on the outcome of antiretroviral therapy in 2007. In: PLOS ONE, 2009, vol. 4, n° 12, p. e8275. doi: 10.1371/journal.pone.0008275 https://archive-ouverte.unige.ch/unige:9287