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Publication Details
AFRICAN RESEARCH NEXUS
SHINING A SPOTLIGHT ON AFRICAN RESEARCH
Triple-class virologic failure in HIV-infected patients undergoing antiretroviral therapy for up to 10 years
Archives of Internal Medicine, Volume 170, No. 5, Year 2010
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Description
Background: Life expectancy of people with human immunodeficiency virus (HIV) is now estimated to approach that of the general population in some successfully treated subgroups. However, to attain these life expectancies, viral suppression must be maintained for decades. Methods: We studied the rate of triple-class virologic failure (TCVF) in patients within the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who started antiretroviral therapy (ART) that included a nonnucleoside reverse-transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) from 1998 onwards. We also focused on TCVF in patients who started a PI/r-containing regimen after a firstline NNRTI-containing regimen failed. Results: Of 45 937 patients followed up for a median (interquartile range) of 3.0 (1.5-5.0) years, 980 developed TCVF (2.1%). By 5 and 9 years after starting ART, an estimated 3.4% (95% confidence interval [CI], 3.1%-3.6%) and 8.6% (95% CI, 7.5%-9.8%) of patients, respectively, had developed TCVF. The incidence of TCVF rose during the first 3 to 4 years on ART but plateaued thereafter. There was no significant difference in the risk of TCVF according to whether the initial regimen was NNRTI or PI/r based (P=.11). By 5 years after starting a PI/r regimen as second-line therapy, 46% of patients had developed TCVF. Conclusions: The rate of virologic failure of the 3 original drug classes is low, but not negligible, and does not appear to diminish over time from starting ART. If this trend continues, many patients are likely to need newer drugs to maintain viral suppression. The rate of TCVF from the start of a PI/r regimen after NNRTI failure provides a comparator for studies of response to secondline regimens in resource-limited settings. ©2010 American Medical Association.
Authors & Co-Authors
Costagliola, Dominique G.
France
Anrs Co4 Fhdh
Reiss, Peter
Netherlands
Athena
Torti, Carlo
Unknown Affiliation
Teira, Ramón M.
Unknown Affiliation
Dorrucci, Maria
Unknown Affiliation
Ledergerber, Bruno
Unknown Affiliation
Mocroft, Amanda J.
Unknown Affiliation
Podzamczer, Daniel
Unknown Affiliation
Cozzi-Lepri, Alessandro
Unknown Affiliation
Obel, Niels
Unknown Affiliation
Masquelier, Bernard
France
Anrs Co3 Aquitaine
Staszewski, Schlomo
Unknown Affiliation
García, Federico Alcacer
Unknown Affiliation
de Wit, Stéphane A.
Unknown Affiliation
Castagna, Antonella
Unknown Affiliation
Antinori, Andrea
Unknown Affiliation
Judd, Ali M.
Unknown Affiliation
Ghosn, Jade
France
Anrs Co6 Primo
Touloumi, Giota
Unknown Affiliation
Mussini, Cristina
Unknown Affiliation
Duval, Xavier
France
Anrs Co8 Copilote
Ramos-Rincón, José Manuel
Unknown Affiliation
Meyer, Laurence J.
France
Anrs Co2 Seroco
Thorne, Claire N.
Unknown Affiliation
Pérez-Hoyos, Santiago
Unknown Affiliation
Morris, Lynn G.
Unknown Affiliation
van Sighem, Ard I.
Netherlands
Athena
Lo Caputo, Sergio
Unknown Affiliation
Günthard, Hüldrych Fritz
Unknown Affiliation
Paredes, Roger
Unknown Affiliation
De Luca, Andrea
Unknown Affiliation
Paraskevis, D. N.
Unknown Affiliation
Kjaer, Jesper
Unknown Affiliation
Chêne, Geneviève
Unknown Affiliation
Lundgren, Jens D.
Unknown Affiliation
Phillips, Andrew N.
Unknown Affiliation
Statistics
Citations: 46
Authors: 36
Affiliations: 6
Identifiers
Doi:
10.1001/archinternmed.2009.472
ISSN:
15383679
Research Areas
Infectious Diseases
Study Design
Cross Sectional Study
Cohort Study