Constance Delaugerre1, Jade Ghosn2, Jean-Marc Lacombe3, Gilles Pialoux4, Lise Cuzin5, Odile Launay6, Amélie Menard7, Pierre de Truchis8, Dominique Costagliola3. 1. INSERM, U941 Université Paris Diderot, Sorbonne Paris Cité AP-HP, Virology, Saint-Louis Hospital. 2. Paris Descartes University, EA 7327, Necker Medical School AP-HP, Unit of Therapeutics in Immunology and Infectiology, Hotel Dieu Hospital. 3. Sorbonne Universités, Université Pierre et Marie Curie (UPMC) Paris 06 INSERM, UMR_S 1136, Institut Pierre Louis d'Epidémiologie et de Santé Publique. 4. Infectious Diseases, UPMC-Tenon Hospital-AP-HP, Paris. 5. Infectious Diseases, CHU Toulouse. 6. Paris Descartes University, AP-HP, Cochin Hospital, Paris. 7. Infectious Diseases, Conception Hospital-APHM, Marseille. 8. Infectious Diseases, Versailles St Quentin en Yvelines University, R Poincare Hospital-AP-HP, Garches, France.
Abstract
BACKGROUND: Calendar trends in virologic failure (VF) among human immunodeficiency virus (HIV)-infected patients can help to evaluate the performance of healthcare systems and the need for new antiretroviral therapy (ART). We examined the time trend in the rate of VF beyond 6 months of ART between 1997 and 2011 in France. METHODS: We included patients from the French Hospital Database on HIV who received at least 6 months of ART. VF was defined as 2 consecutive plasma HIV-RNA values >500 copies/mL or as 1 value >500 copies/mL followed by a treatment switch. We adjusted for patients' characteristics by fitting a multivariable generalized estimating equation logistic regression model with an exchangeable covariance matrix. RESULTS: A total of 81 738 patients were enrolled, and median follow-up was 112.4 months. Median CD4 count was 333 cells/µL, and 23% of patients had HIV infection classified as Centers for Disease Control and Prevention stage C. Overall, 29.3% of patients received single/dual-drug ART initially, and 45.4% of patients experienced at least 1 episode of VF during follow-up. The percentage of patients with VF fell from 61.5% in 1997-1998 to 9.7% in 2009-2011 (P < .0001). Factors associated with the lower frequency of VF were recent calendar period, a higher contemporary CD4 cell count, and first-line regimens based on nonnucleoside reverse transcriptase inhibitors or integrase inhibitors. CONCLUSIONS: The proportion of HIV-infected patients experiencing VF during routine care fell markedly between 1997 and 2009-2011, to only 9.7%. This was attributed to the advent of fully active and better-tolerated antiretroviral drugs, and to national guidelines recommending rapid management of VF after mid-2000.
BACKGROUND: Calendar trends in virologic failure (VF) among human immunodeficiency virus (HIV)-infectedpatients can help to evaluate the performance of healthcare systems and the need for new antiretroviral therapy (ART). We examined the time trend in the rate of VF beyond 6 months of ART between 1997 and 2011 in France. METHODS: We included patients from the French Hospital Database on HIV who received at least 6 months of ART. VF was defined as 2 consecutive plasma HIV-RNA values >500 copies/mL or as 1 value >500 copies/mL followed by a treatment switch. We adjusted for patients' characteristics by fitting a multivariable generalized estimating equation logistic regression model with an exchangeable covariance matrix. RESULTS: A total of 81 738 patients were enrolled, and median follow-up was 112.4 months. Median CD4 count was 333 cells/µL, and 23% of patients had HIV infection classified as Centers for Disease Control and Prevention stage C. Overall, 29.3% of patients received single/dual-drug ART initially, and 45.4% of patients experienced at least 1 episode of VF during follow-up. The percentage of patients with VF fell from 61.5% in 1997-1998 to 9.7% in 2009-2011 (P < .0001). Factors associated with the lower frequency of VF were recent calendar period, a higher contemporary CD4 cell count, and first-line regimens based on nonnucleoside reverse transcriptase inhibitors or integrase inhibitors. CONCLUSIONS: The proportion of HIV-infectedpatients experiencing VF during routine care fell markedly between 1997 and 2009-2011, to only 9.7%. This was attributed to the advent of fully active and better-tolerated antiretroviral drugs, and to national guidelines recommending rapid management of VF after mid-2000.
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