Durability of first antiretroviral treatment in HIV chronically infected patients: why change and what are the outcomes?

Abstract

IntroductionFirst antiretroviral therapy (ART) is often switched to simpler, more potent or better tolerated regimens [1, 2]. Although discontinuation rates are frequently studied, the durability of regimens is rarely approached.Materials and MethodsRetrospective study with the following objectives: analyze first ART schemes and their durability in naive patients with chronic HIV-1 and 2 infections, evaluate factors influencing ART change, second-line ART and consequent virologic and immunologic responses. Patients had follow-ups in a Central University Hospital, started ART between January 2007 and December 2012 and changed first regimens. Clinical data was obtained from medical records and analyzed using the Statistical Package for the Social Sciences (version 20).ResultsOf the 652 naive patients who started ART, 164 changed regimens. The majority had HIV-1 infection (n=158). The mean age was 43.9 years (standard deviation±14.3), with a male predominance of 57.9%. Regimens with efavirenz were the most common amongst HIV-1 patients (50%) followed by lopinavir/r (22%). In HIV-2 patients, lopinavir/r (n=3) regimens were most prevalent. First ART regimens had a mean duration of 12.1 months. There was no difference between NNRTI (59.8%) and protease inhibitor (40.2%) schemes regarding durability. Adverse reactions were the major cause of ART switching (55.5%) followed by therapy resistance (12.1%). Age was inversely related to durability (p=0.007 Mann-Whitney, Phi coefficient −0.161) and associated with the appearance of adverse reactions (p=0.04, Chi-square). Younger patients had a reduced risk of adverse reactions by 27%. Adverse reactions increased the risk of inferior durability by 40%. Psychiatric symptoms (28.4%) were the most prevalent, all attributed to efavirenz. The year of ART initiation was associated with different durability rates (p=0.005, Mann-Whitney). Patients started on ART before the year 2010 reduced the probability of inferior ART duration by 25.8%. After second-line ART regimens, TCD4+ counts>500 cell/µL were increased by 38% and favourable virologic outcome achieved in 84%.ConclusionsAdverse reactions were the main cause for ART switching, supporting a cautious approach when initiating regimens, particularly in older patients. All ART naive patients who changed initial therapy had favourable immunological and virologic responses.

The Factors Related to CD4+ T-Cell Recovery and Viral Suppression in Patients Who Have Low CD4+ T Cell Counts at the Initiation of HAART: A Retrospective Study of the National HIV Treatment Sub-Database of Zhejiang Province, China, 2014

“…Some studies suggested first antiretroviral therapy was often switched to simpler, more potent, better-tolerated regimens than the replaced regimen [ 37 , 38 ]. Previous studies demonstrated that side effect of patients who changed regimens during the treatment such as toxicity [ 39 ], experienced virological failure and resistance-conferring mutations within the viral genome than the patients who never changed the regimen, mainly reason due to poor compliance [ 40 , 41 ]. Other studies showed that the effect was significant better after changing the regimen, the median CD4+ count increased from 157 cells/μL at baseline to 307 cells/μL in 120 weeks [ 42 ].…”

Predicting the Antiretroviral Medication Adherence and CD4 Measure in Patients with HIV/AIDS Based on the Post Traumatic Stress Disorder and Depression

“…High levels of adherence to the medication are necessary for successful medication (7). However, considering the availability of ART, people living with HIV (PLWH) are not uniformly responsive to treatment (8) and there is nearly 50% to 80% of nonadherence to the medication (9)(10)(11) and poor adherence is a primary factor in suboptimal treatment response (12). The reasons for nonadherence are various (13); side effects of the antiretroviral medication such as nausea or anemia and a number of psychological factors play an important role in the impaired adherence to the antiretroviral therapy (14).…”

PTSD co-morbid with HIV: Separate but equal, or two parts of a whole?

“…The advent of highly active antiretroviral therapy (ART) dramatically reduced AIDS-related mortality such that approximately 30 million people currently live with HIV around the globe ( Hallett et al, 2014 ). However, despite the availability of ART, people living with HIV (PLWH) are not uniformly responsive to treatment ( Moniz et al, 2014 ), and poor adherence is a primary factor in suboptimal treatment response ( Li et al, 2014 ). Incidents of stressful life events predict nonadherence and increased odds of virologic failure ( Safren et al, 2003 ; Mugavero et al, 2009 ), possibly through avoidant coping ( Martinez et al, 2012 ).…”