Comparison of Antiretroviral Therapy Regimens in Terms of Virological Response, Immunological Response and Adverse Effects in Treatment-Naive HIV-Positive Patients

Abstract

Objective: In this study, we aimed to determine the demographic and clinical characteristics of HIV-positive patients seen in our faculty; and to put forward the differences in virological response, immunological response and adverse effects of administered antiretroviral therapy (ART) regimens in these patients. Methods: Medical records of 175 HIV-positive patients over 18 years old followed between 2003 and 2015 and have not been treated before, and regularly monitored for a minimum of six months from the beginning of the therapy were included in the study. Demographic, clinical and laboratory data of patients were collected retrospectively. IBM SPSS Statistics for Windows. Version 21.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, USA) was used in statistical analysis of the study data. Results: Mostly used ART regimens in our outpatient clinic were ritonavir-boosted lopinavir (LPV/r) (n=102) and efavirenz (EFV) (n=39) combined with tenofovir/emtricitabine (TDF/FTC). Patients who used LPV/r were in a more advanced disease stage. Acquisition rate of virological response was 59% in the group receiving EFV and 53.9% in the group receiving LPV/r. The average increase in CD4+ T lymphocyte count at the sixth month of therapy was 258±222/μL in LPV/r group, 189±197/ μL in EFV group. The rate of increase in CD4+ T lymphocyte count was in favor of LPV/r group (p=0.017). Skipped drug doses (p=0.211), clinical adverse effects (p=0.276) and modification in ART regimen (p=0.044) were more common in EFV group. Increased cholesterol and low-density lipoprotein (LDL) level and decreased high-density lipoprotein (HDL) level were seen Özet Amaç: Fakültemizde izlenen HIV-pozitif hastaların demografik ve klinik özelliklerinin belirlenmesi ve bu hastalara uygulanan antiretroviral tedavi (ART) rejimleri arasında virolojik yanıt, immünolojik yanıt ve istenmeyen etkiler açısından ne gibi farklar olduğunun ortaya konulması amaçlandı. Yöntemler: 2003-2015 yıllarında polikliniğimizde izlenen, HIV infeksiyonu nedeniyle daha önce herhangi bir tedavi görmemiş ve ilk kez başlanan ART'nin en az altı aydır düzenli olarak sürdürüldüğü 18 yaşından büyük 175 hasta çalışma kapsamına alındı. Bu hastaların demografik, laboratuvar ve klinik bilgileri retrospektif olarak toplandı. Çalışma verilerinin istatistiksel analizinde IBM SPSS Statistics for Windows. Version 21.0 (Statistical Package for the Social Sciences, IBM Corp., Armonk, NY, ABD) kullanıldı. Bulgular: Hastalarda en çok kullanılan rejimler, tenofovir/emtrisitabin (TDF/FTC)'in ritonavirle güçlendirilmiş lopinavir (LPV/r) (n=102) ya da efavirenz (EFV) (n=39) ile kombine edildiği rejimlerdi. LPV/r uygulananların arasında daha ileri evrelerdeki hastalar ağır basmaktaydı; bu hastalarda eşlik eden fırsatçı infeksiyonlar ve profilaktik ilaç kullanımı da daha fazlaydı (p<0.05). Virolojik yanıt elde etme oranı, EFV alan grupta %59; LPV/r alan grupta %53.9'du. Tedavinin 6. ayında CD4+ T lenfositi sayısındaki ortalama artış, LPV/r grubunda 258±222/μl, EFV grubunda 189±197/μl ol...

Assessment of the 24th Week Success of Anti-Retroviral Therapy in the Action against HIV in Istanbul Database: Results from a Region with Increasing Incidence

“…This trend might be explained by the reduction in pill count with NNRTIbased regimens and higher adherence to the treatment. In a study from Turkey, the authors reported good adherence to PI-based regimens with advanced stage of the disease and fewer adverse effects of PI-based regimens compared with NRTI-based regimens even with lower pill counts (19). In the subgroup analyses of the NRTI-based regimen group in our study, it is notable that patients were not in advanced CDC stages of the disease and had a higher baseline CD4+ cell count.…”

“…In another study that compared treatment regimens using VF and IF, in which TDF FTC was the backbone and LPV r or EFV was the 3rd agent, the authors concluded that the regimen that included LPV r was more successful immunologically. In this study, the success of certain treatment regimens, adherence to treatment, and adverse effects were assessed rather than factors influencing treatment success (19). Therefore, to the best of our knowledge, our study is the first in Turkey to assess treatment success with regard to probable risk factors.…”

Changes in Virological and Immunological Indicators, Renal Functions, and Lipid Profiles After Switching to Tenofovir Alafenamide/Emtricitabine/Bictegravir in Treatment Experienced People Living with HIV

“…Tedavi değişikliği sonrası izlemde kullanılacak parametreler kılavuzlarda benzerdir (2)(3). Bununla birlikte, tedavi yanıtının ve yan etkilerin yakın takibi gerekmektedir (4). Literatürde tedavi değişikliği sonrası tedavi yanıtı, yan etki ve uzun dönem takibi açısından sınırlı sayıda gerçek yaşam verisi bulunmaktadır.…”