Predictors of late virologic failure after initial successful suppression of HIV replication on efavirenz-based antiretroviral therapy.

Q2 Medicine
HIV Clinical Trials Pub Date : 2016-01-01 Epub Date: 2016-07-29 DOI:10.1080/15284336.2016.1201300
Isaac Singini, Thomas B Campbell, Laura M Smeaton, Nagalingeswaran Kumarasamy, Alberto La Rosa, Sineenart Taejareonkul, Steven A Safren, Timothy P Flanigan, James G Hakim, Michael D Hughes
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引用次数: 6

Abstract

Background: Practical issues, including cost, hinder implementing virologic monitoring of patients on antiretroviral therapy (ART) in resource-limited settings. We evaluated factors that might guide monitoring frequency and efforts to prevent treatment failure after initial virologic suppression.

Methods: Participants were the 911 HIV-infected antiretroviral-naïve adults with CD4 count <300 cells/μL who started efavirenz-based ART in the international A5175/PEARLS trial and achieved HIV-1 RNA <1000 copies/mL at 24 weeks. Participant report of ART adherence was evaluated using a structured questionnaire in monthly interviews. Adherence and readily available clinical and laboratory measures were evaluated as predictors of late virologic failure (late VF: confirmed HIV-1 RNA ≥1000 copies/mL after 24 weeks).

Results: During median follow-up of 3.5 years, 82/911 participants (9%) experienced late VF. Of 516 participants reporting missed doses during the first 24 weeks of ART, 55 (11%) experienced late VF, compared with 27 (7%) of 395 participants reporting no missed doses (hazard ratio: 1.73; 95% CI: 1.08, 2.73). This difference persisted in multivariable analysis, in which lower pre-ART hemoglobin and absence of Grade ≥3 laboratory results prior to week 24 were also associated with higher risk of late VF.

Discussion: In this clinical trial, the late VF rate after successful suppression was very low. If achievable in routine clinical practice, virologic monitoring involving infrequent (e.g. annual) measurements might be considered; the implications of this for development of resistance need evaluating. Patients reporting missed doses early after ART initiation, despite achieving initial suppression, might require more frequent measurement and/or strategies for promoting adherence.

Abstract Image

以依非韦伦为基础的抗逆转录病毒治疗最初成功抑制HIV复制后晚期病毒学失败的预测因素。
背景:包括成本在内的实际问题阻碍了在资源有限的环境中对接受抗逆转录病毒治疗(ART)的患者进行病毒学监测。我们评估了可能指导监测频率和努力防止初始病毒学抑制后治疗失败的因素。结果:在中位3.5年的随访期间,911名参与者中有82人(9%)经历了晚期VF。在516名报告在抗逆转录病毒治疗的前24周遗漏剂量的参与者中,55名(11%)经历了晚期VF,相比之下,395名参与者中有27名(7%)报告没有遗漏剂量(风险比:1.73;95% ci: 1.08, 2.73)。这种差异在多变量分析中仍然存在,在第24周之前较低的art前血红蛋白和没有≥3级实验室结果也与晚期VF的高风险相关。讨论:在本临床试验中,成功抑制后的晚期VF率非常低。如果在常规临床实践中可以实现,可以考虑进行不经常(例如每年)测量的病毒学监测;这对耐药性发展的影响有待评估。在抗逆转录病毒治疗开始后早期报告漏给剂量的患者,尽管获得了最初的抑制,可能需要更频繁的测量和/或策略来促进依从性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
HIV Clinical Trials
HIV Clinical Trials 医学-传染病学
CiteScore
1.76
自引率
0.00%
发文量
0
审稿时长
>12 weeks
期刊介绍: HIV Clinical Trials is devoted exclusively to presenting information on the latest developments in HIV/AIDS clinical research. This journal enables readers to obtain the most up-to-date, innovative research from around the world.
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