Outcome and Predictors of Failure of Highly Active Antiretroviral Therapy: One‐Year Follow‐Up of a Cohort of Human Immunodeficiency Virus Type 1–Infected Persons

Wit, Ferdinand W. N. M.; Leeuwen, Remko van; Weverling, Gerrit Jan; Jurriaans, Suzanne; Nauta, Klaas; Steingrover, Radjin; Schuijtemaker, Johan; Eyssen, Xander; Fortuin, David; Weeda, M.; Wolf, Frank de; Reiss, Peter; Danner, Sven A.; Lange, Joep M. A.

doi:10.1086/314675

Cited by 161 publications

(71 citation statements)

References 22 publications

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“…As it has been reported in other studies (25,(30)(31)(32)(33)(34) HAART produced a substantial increase in CD4 cell counts in our study. In this study, with initial over all baseline mean CD4 count of 132.9 cells/mm 3 , showed a mean increase in CD4 count of 203.0 cells/mm 3 .…”

supporting

confidence: 91%

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Wabe¹,

Alemu²

2012

Gaziantep Med J

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The survival benefits of highly active antiretroviral therapy (HAART) in HIV infected patients have been studied well in the developed world. In resource poor settings like Ethiopia such treatment was started only in 2003. As a result, the existing treatment guidelines and recommendations are based on data from the developed world. The objective of this study was to determine the immunological and clinical progress in HIV/AIDS patients in one year data review of patients' card who initiated on HAART in Ethiopia. A retrospective cohort study was done based on past medical records of HIV/AIDS patients, using a structured data collection format. All patient cards of one year data with patients who initiated HAART from October 1, 2006 to November 30, 2007 were included in the study. The data collected was analyzed using SPSS for window version 16.0. The majority of the study population (383, 64.2%) were prescribed zidovudine/lamivudine/neverapine (ZDV/3TC/NVP) regimen initially. Overall functional status change showed that ability to work was increased by 31.5%, being ambulatory decreased by 93.4% and bedridden status decreased by 80%. A total of 240 (46.9%) patients have showed functional status improvement. Average mean weight change of 5.9 kg (increment by 11.9%) was seen during a one year follow-up. The patients showed immunological change from 132.883 mean CD4/mm 3 count to 335.87 mean CD4/mm 3 . About 492 (82.4%) patients present with different type of opportunistic infections (OIs) at start of therapy which dramatically dropped to only 40 (6.7%) patient after one year of receiving HAART. HAART initiation has decreased progression of the diseases and improved the patients' quality of life. Most patients have showed a significant increment in their CD4 count. The restoration of CD4 in turn has improved the clinical status of most patients. Despite the significant progression of health of patients, greater immunological and clinical success should be attained by encouraging patients for effective use of those lifesaving drugs with maximal adherence. 2) başlangıçta zidovudin/lamivudin/neverapin (ZDV/3TC/NVP) tedavisi verilmişti. Genelde fonksiyonel durum değişimi, çalışma yeteneğinin %31.5 arttığını, ayakta tedavi edilmenin %93.4 azaldığını, yatağa bağlı kalma durumunun %80 azaldığını gösterdi. Toplam 240 hasta fonksiyonel durum düzelmesi gösterdi. Bir yıllık izleme sırasında 5.9 kg ortalama ağırlık değişimi (%11.9 artma) gözlendi. Hastalar ortalama 132.883 CD4/mm 3 sayımından ortalama 335.87 CD4/mm 3 'e immünolojik değişim gösterdi. Tedavinin başlamasında farklı tipte fırsatçı enfeksiyonu bulunan yaklaşık 492 (%82.4) hasta, HAART tedavisi başlamasından bir yıl sonra dramatik olarak sadece 40'a (%6.7) düştü. HAART tedavisi başlanması hastalığın ilerlemesini azalttı ve hastaların yaşam kalitesini iyileştirdi. Hastaların çoğu CD4 sayılarında anlamlı artışlar gösterdi. CD4'deki düzelme birçok hastanın klinik durumunu iyileştirdi. Hastaların sağlığındaki anlamlı iyileşmeye karşın, hayat kurtaran bu ilaçlara d...

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supporting

confidence: 91%

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Wabe¹,

Alemu²

2012

Gaziantep Med J

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“…Twelve cohorts contributed data: the French Hospital Database on HIV (FHDH) ANRS CO4 [6] and the Aquitaine Cohort ANRS CO3 (France) [7]; the AIDS Therapy Evaluation Project Netherlands (ATHENA) [8]; the Italian Cohort of Antiretroviral-Naive Patients (ICONA) [9]; the Swiss HIV Cohort Study (SHCS) [10]; the Frankfurt HIV Cohort [11] and Köln/Bonn Cohort (Germany) [12]; the EuroSIDA study (20 countries in Europe and Argentina) [13]; the Collaborations in HIV Outcomes Research US (CHORUS; USA) [14]; the Royal Free Hospital Cohort (UK) [15]; and the British Columbia Centre for Excellence in HIV/AIDS [16] and the South Alberta Clinic (Canada) [17]. At all sites, institutional review boards had approved the collection of data.…”

Section: Methodsmentioning

confidence: 99%

Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

May

Sterne²,

Sabin³

et al. 2007

Aids

255

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Objective-To estimate the prognosis over 5 years of HIV-1-infected, treatment-naive patients starting HAART, taking into account the immunological and virological response to therapy.Design-A collaborative analysis of data from 12 cohorts in Europe and north America on 20 379 adults who started HAART between 1995 and 2003.Methods-Parametric survival models were used to predict the cumulative incidence at 5 years of a new AIDS-defining event or death, and death alone, first from the start of HAART and second from 6 months after the start of HAART. Data were analysed by intention-to-continuetreatment, ignoring treatment changes and interruptions.Results-During 61 798 person-years of follow-up, 1005 patients died and an additional 1303 developed AIDS. A total of 10 046 (49%) patients started HAART either with a CD4 cell count of less than 200 cells/μl or with a diagnosis of AIDS. The 5-year risk of AIDS or death (death alone) from the start of HAART ranged from 5.6 to 77% (1.8-65%), depending on age, CD4 cell count, HIV-1-RNA level, clinical stage, and history of injection drug use. From 6 months the corresponding figures were 4.1-99% for AIDS or death and 1.3-96% for death alone.Conclusion-On the basis of data collected routinely in HIV care, prognostic models with high discriminatory power over 5 years were developed for patients starting HAART in industrialized countries. A risk calculator that produces estimates for progression rates at years 1 to 5 after starting HAART is available from www.art-cohort-collaboration.org. KeywordsAIDS; antiretroviral therapy; CD4 lymphocyte count; highly active; HIV infections; mortality; prognosis; risk factors; survival analysis; viral load IntroductionEstimates of the probability of progression to AIDS or death are important for HIV-infected patients starting HAART and their treating physicians. Such estimates are also needed for a better understanding of the treated history of HIV infection, to monitor and predict the course of the epidemic, to develop treatment guidelines, and to plan health services.The Antiretroviral Therapy (ART) Cohort Collaboration, an international collaboration between the investigators of cohort studies from Europe and north America, was established in 2000 to monitor disease progression among treatment-naive patients starting HAART [1,2]. Pre-HAART era probabilities of progression by viral load and CD4 cell count were Mellors and colleagues [3] using the Multicenter AIDS Cohort Study (MACS) of homosexual men. In that study, the probability of progression to AIDS within 3 years for those with a high viral load and CD4 cell count between 201 and 350 cells/μl was estimated to be 64%, rising to 89% at 6 years. Since the introduction of HAART, the incidence of AIDS in treated patients has declined markedly. Previous analyses from the ART Cohort Collaboration showed that for those aged under 50 years and starting HAART in the same viral load and CD4 cell count stratum, the 3-year probability of AIDS or death had fallen to 6% [1].As treatment wi...

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“…This policy has caused considerable impact on the HIV/AIDS epidemic, reducing morbidity and mortality [1]; however, roughly 50% of patients who initiate ARV have some type of therapeutic failure six months later [2]. This percentage is even higher in treatment-experienced patients who have changed therapy at least once [3]. Consequently, the effectiveness of this program is threatened by the emergence of resistant viral strains selected during treatment, which may be transmitted to other individuals.…”

mentioning

confidence: 99%

Treatment switch guided by HIV-1 genotyping in Brazil

Tupinambás¹,

Ribeiro²,

Aleixo³

et al. 2006

Braz J Infect Dis

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We assessed the performance of HIV-1 genotyping tests in rescue therapy. Patients were divided into two groups: group 1 (genotyped), included those switching to new antiretroviral drugs based on HIV-1 genotyping data, and group 2 (standard of care -SOC), comprised those in rescue therapy who had not used this test. This was an open and non-randomized study, with 74 patients, followed up for a mean period of 12 months, from February 2002 to May 2003. The groups differed in the duration of antiretroviral use, experience with diverse drug classes (non-nucleoside reverse transcriptase inhibitors and protease inhibitors) and viral load <2.6 log 10 copies/mL at any time during treatment. In 23 patients (group 1), the switch in antiretroviral (ARV) regimen was based on genotyping data; this test was not used for 51 patients (group 2). Two CD 4 + lymphocyte counts and viral load counts were made for each patient during the study. Data from the pharmacy where patients received antiretroviral agents, medical charts, and direct interviews with patients to assess compliance to treatment, were analyzed. In the genotyped group, the average drop in viral load was 2.8 log 10 , compared with a 1.5 log 10 difference in group 2; the difference was significant in the first assessment performed six months after switching (p=0.001). Considering the patients with viral load < 2.6 log 10 (400 copies/mL) after switching, the patients in group 1 had a better performance in the first assessment (73.9% versus 31.1% in groups 1 and 2, respectively); this difference was significant (p=0.001). In multivariate analysis, the variables associated with a greater drop in viral load in the first assessment were the patients whose switching was based on genotyping (group 1), those with a past history of viral load < 2.6 log 10 and correct use of antiretroviral agents. In conclusion, the genotyping test and adherence were found to be independent factors for success in the management of patients who failed treatment.

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Outcome and Predictors of Failure of Highly Active Antiretroviral Therapy: One‐Year Follow‐Up of a Cohort of Human Immunodeficiency Virus Type 1–Infected Persons

Cited by 161 publications

References 22 publications

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Immunological and clinical progress of HIV-infected patients on highly active antiretroviral therapy in north west Ethiopia

Prognosis of HIV-1-infected patients up to 5 years after initiation of HAART: collaborative analysis of prospective studies

Treatment switch guided by HIV-1 genotyping in Brazil

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