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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
medicine
Predictors of Virological Failure and Time to Viral Suppression of First-Line Integrase Inhibitor-Based Antiretroviral Treatment
Clinical Infectious Diseases, Volume 73, No. 7, Year 2021
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Description
Background: Integrase strand transfer inhibitors (InSTIs) are recommended for first-line treatment of persons with human immunodeficiency virus (HIV). We identified risk factors, including baseline minor InSTI resistance mutations, for treatment failure of InSTI-based regimens. Methods: We studied time-to-treatment failure and time to viral suppression among 1419 drug-naive patients in the Swiss HIV Cohort Study. We performed Cox regression models adjusted for demographic factors, baseline HIV RNA/CD4 cell counts, AIDS-defining events, and the type of InSTI. In 646 patients with a baseline genotypic resistance test of the integrase, we studied the impact of minor integrase resistance mutations. Results: We observed 121 virological failures during 18 447 person-years of follow-up. A baseline viral load ≥100 000 copies/mL (multivariable hazard ratio [mHR], 2.2; 95% confidence interval [CI], 1.3-3.6) and an AIDS-defining event (mHR, 1.8; 95% CI. 1.1-3.0) were associated with treatment failure. CD4 counts between 200 and 500 cells/μL (mHR, 0.5; 95% CI,. 3-.8) and >500 cells/μL (mHR, 0.4; 95% CI,. 2-.7) were protective. Time to suppression was shorter in lower viral load strata (mHR, 0.7; 95% CI,. 6-.8) and in dolutegravir-based therapy (mHR, 1.2; 95% CI, 1.0-1.4). Minor resistance mutations were found at baseline in 104 of 646 (16%) patients with no effect on treatment outcome. Conclusions: Factors associated with treatment failure on InSTI-based first-line regimen remained similar to those of older treatments, in particular high viral load and low CD4 counts. © 2020 The Author(s). Published by Oxford University Press for the Infectious Diseases Society of America.
Authors & Co-Authors
Scherrer, Alexandra U.
Switzerland, Zurich
Universitatsspital Zurich
Switzerland, Zurich
Universität Zürich
Kouyos, Roger D.
Switzerland, Zurich
Universitatsspital Zurich
Switzerland, Zurich
Universität Zürich
Huber, Michael J.
Switzerland, Zurich
Universität Zürich
Hirsch, Hans H.
Switzerland, Basel
Universitat Basel
Perreau, Matthieu
Switzerland, Lausanne
Université de Lausanne Unil
Yerly, Sabine T.B.D.
Switzerland, Geneva
Université de Genève
Calmy, Alexandra L.
Switzerland, Geneva
Université de Genève
Cavassini, Matthias
Switzerland, Lausanne
Centre Hospitalier Universitaire Vaudois
Stöckle, Marcel
Switzerland, Basel
Universitat Basel
Furrer, Hansjakob Jackob
Switzerland, Bern
University of Bern
Vernazza, Pietro Luigi
Switzerland, St Gallen
Kantonsspital St.gallen
Bernasconi, Enos
Switzerland, Bellinzona
Ente Ospedaliero Cantonale
Günthard, Huldrych F.
Switzerland, Zurich
Universitatsspital Zurich
Switzerland, Zurich
Universität Zürich
Aebi-Popp, Karoline
Unknown Affiliation
Anagnostopoulos, Alexia
Unknown Affiliation
Battegay, Manuel
Unknown Affiliation
Bernasconi, Enos
Unknown Affiliation
Böni, Jürg
Unknown Affiliation
Braun, Dominique Laurent
Unknown Affiliation
Bucher, Heíner C.C.
Unknown Affiliation
Calmy, Alexandra
Unknown Affiliation
Cavassini, Matthias
Unknown Affiliation
Ciuffi, Angela
Unknown Affiliation
Dollenmaier, Guenter
Unknown Affiliation
Egger, Matthias
Unknown Affiliation
Elzi, Luigia
Unknown Affiliation
Fehr, Jan Sven
Unknown Affiliation
Fellay, Jacques
Unknown Affiliation
Fux, Christoph Andreas
Unknown Affiliation
Günthard, Huldrych F.
Unknown Affiliation
Haerry, David Hans Ulrich
Unknown Affiliation
Hasse, Barbara Katharina
Unknown Affiliation
Hoffmann, Matthias
Unknown Affiliation
Kahlert, Christian R.
Unknown Affiliation
Kaiser, Laurent K.
Unknown Affiliation
Keiser, Olivia
Unknown Affiliation
Klimkait, Thomas
Unknown Affiliation
Kouyos, Roger D.
Unknown Affiliation
Kovari, Helen
Unknown Affiliation
Ledergerber, Bruno
Unknown Affiliation
Martinetti, Gladys
Unknown Affiliation
Martinez de Tejada, Begoña
Unknown Affiliation
Marzolini, Catia
Unknown Affiliation
Metzner, K. J.
Unknown Affiliation
Müller, Nicolas J.
Unknown Affiliation
Nicca, Dunja
Unknown Affiliation
Paioni, Paolo
Unknown Affiliation
Pantaleo, Giuseppe P.
Unknown Affiliation
Rauch, Andri
Unknown Affiliation
Rudin, Christoph
Unknown Affiliation
Schmid, Patrick
Unknown Affiliation
Speck, Roberto F.
Unknown Affiliation
Trkola, Alexandra
Unknown Affiliation
Vernazza, Pietro L.
Unknown Affiliation
Wandeler, Gilles
Unknown Affiliation
Weber, Rainer
Unknown Affiliation
Yerly, Sabine
Unknown Affiliation
Statistics
Citations: 18
Authors: 57
Affiliations: 9
Identifiers
Doi:
10.1093/cid/ciaa1614
ISSN:
10584838
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study
Study Approach
Quantitative