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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
immunology and microbiology
Treatment switches after viral rebound in HIV-infected adults starting antiretroviral therapy: Multicentre cohort study: The United Kingdom Collaborative HIV Cohort (CHIC) Study
AIDS, Volume 22, No. 15, Year 2008
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Description
Objective: To describe the time from first viral rebound on highly active antiretroviral therapy to first treatment change, identify factors associated with more rapid switching, and investigate whether treatment changes are in line with treatment guidelines. Design and setting: A multicentre cohort study. Methods: We described the time to first treatment switch among individuals experiencing confirmed virological rebound after initiating highly active antiretroviral therapy; factors associated with more rapid switching were identified using proportional hazards regression and predictors of a switch in line with guidelines were identified using logistic regression. Results: Thirty-four percent of the 694 patients experiencing virological rebound remained on a failing regimen for more than 6 months. Factors associated with more rapid switching were lower CD4 cell count (hazard ratio, 0.84/100 cells/μl higher, P < 0.001 ), higher viral load (1.29 /Iog10 copies/ml higher, P < 0.001), older age (1.06/ 5 years older, P = 0.07), and changing/adding drugs to the regimen prior to rebound (1.16, P = 0.16). Two hundred and eighteen of the 394 treatment changes (55%) were in line with guidelines; those receiving nonnucleoside reverse transcriptase inhibitor-containing regimens were more likely to make changes in line with guidelines (adjusted odds ratio, 2.80, P< 0.001), whereas those who had previously added drugs to their regimen were less likely to make changes in line with guidelines (0.15, P = 0.001). Conclusion: A substantial minority of patients remain on a failing highly active antiretroviral therapy regimen for periods of 6 months or longer without adding new drugs. Changes made are often not in line with treatment guidelines, raising concerns about the development of resistance and long-term clinical outcomes in these individuals. © 2008 Wolters Kluwer Health | Lippincott Williams & Wilkins.
Authors & Co-Authors
Sabin, Caroline Anne
United Kingdom, London
Ucl Medical School
Lee, Katherine Jane
United Kingdom, London
Mrc Clinical Trials Unit
Dunn, David T.
United Kingdom, London
Mrc Clinical Trials Unit
Porter, Kholoud
United Kingdom, London
Mrc Clinical Trials Unit
Hill, Teresa
United Kingdom, London
Ucl Medical School
Phillips, Andrew N.
United Kingdom, London
Ucl Medical School
Schwenk, Achim
United Kingdom, Wakefield
Nhs England
Leen, Clifford L.S.
United Kingdom, Edinburgh
Western General Hospital
Delpech, Valerie C.
United Kingdom, London
Public Health England
Anderson, Jane
United Kingdom, London
Homerton University Hospital Nhs Foundation Trust
Gazzard, Brian George L.
United Kingdom, London
Chelsea and Westminster Hospital
Johnson, Margaret A.
United Kingdom, London
Royal Free London Nhs Foundation Trust
Easterbrook, Philippa Jane
United Kingdom, London
King's College London
Walsh, John Christopher
United Kingdom, London
Imperial College Healthcare Nhs Trust
Fisher, Martin J.
United Kingdom, Wakefield
Nhs England
Orkin, Chloë M.
United Kingdom, London
The Royal London Hospital
Statistics
Citations: 20
Authors: 16
Affiliations: 11
Identifiers
Doi:
10.1097/QAD.0b013e32830e4cf3
ISSN:
02699370
Research Areas
Environmental
Infectious Diseases
Study Design
Cohort Study
Case-Control Study
Study Approach
Quantitative