Nicola Gianotti1, Patrizia Lorenzini2, Alessandro Cozzi-Lepri3, Andrea De Luca4, Giordano Madeddu5, Laura Sighinolfi6, Carmela Pinnetti2, Carmen Santoro7, Paola Meraviglia8, Cristina Mussini9, Andrea Antinori2, Antonella d'Arminio Monforte10. 1. Department of Infectious Diseases, San Raffaele Scientific Institute, Milan, Italy. 2. Clinical Division, National Institute for Infectious Diseases 'Lazzaro Spallanzani' IRCCS, Rome, Italy. 3. Institute for Global Health, University College London, London, UK. 4. Infectious Diseases Unit, Azienda Ospedaliera Universitaria Senese, Department of Medical Biotechnologies, University of Siena, Siena, Italy. 5. Department of Clinical and Experimental Medicine, University of Sassari, Sassari, Italy. 6. Department of Infectious Diseases, S. Anna Hospital, Ferrara, Italy. 7. Clinic of Infectious Diseases, University of Bari, University Hospital Policlinico, Bari, Italy. 8. Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy. 9. Infectious Disease Clinic, Department of Medical and Surgical Sciences for Children & Adults, University of Modena and Reggio Emilia, Modena, Italy. 10. Clinic of Infectious and Tropical Diseases, ASST Santi Paolo and Carlo, Department of Health Sciences, University of Milan, Milan, Italy.
Abstract
OBJECTIVES: Our aim was to investigate the durability of different initial regimens in patients starting ART with CD4+ counts <200 cells/mm3 and HIV-RNA >5 log10 copies/mL. METHODS: This was a retrospective study of HIV-infected patients prospectively followed in the ICONA cohort. Those who started ART with boosted protease inhibitors (bPIs), NNRTIs or integrase strand transfer inhibitors (InSTIs), with CD4+ <200 cells/mm3 and HIV-RNA >5 log10 copies/mL, were included. The primary endpoint was treatment failure (TF), a composite endpoint defined as virological failure (VF, first of two consecutive HIV-RNA >50 copies/mL after 6 months of treatment), discontinuation of class of the anchor drug or death. Independent associations were investigated by Poisson regression analysis in a model including age, gender, mode of HIV transmission, CDC stage, HCV and HBV co-infection, pre-treatment HIV-RNA, CD4+ count and CD4+/CD8+ ratio, ongoing opportunistic disease, fibrosis FIB-4 index, estimated glomerular filtration rate, haemoglobin, platelets, neutrophils, calendar year of ART initiation, anchor drug class (treatment group) and nucleos(t)ide backbone. RESULTS: A total of 1195 patients fulfilled the inclusion criteria: 696 started ART with a bPI, 315 with an InSTI and 184 with an NNRTI. During 2759 person-years of follow up, 642 patients experienced TF. Starting ART with bPIs [adjusted incidence rate ratio (aIRR) (95% CI) 1.62 (1.29-2.03) versus starting with NNRTIs; P < 0.001] and starting ART with InSTIs [aIRR (95% CI) 0.68 (0.48-0.96) versus starting with NNRTIs; P = 0.03] were independently associated with TF. CONCLUSIONS: In patients starting ART with <200 CD4+ cells/mm3 and >5 log10 HIV-RNA copies/mL, the durability of regimens based on InSTIs was longer than that of NNRTI- and bPI-based regimens.
OBJECTIVES: Our aim was to investigate the durability of different initial regimens in patients starting ART with CD4+ counts <200 cells/mm3 and HIV-RNA >5 log10 copies/mL. METHODS: This was a retrospective study of HIV-infectedpatients prospectively followed in the ICONA cohort. Those who started ART with boosted protease inhibitors (bPIs), NNRTIs or integrase strand transfer inhibitors (InSTIs), with CD4+ <200 cells/mm3 and HIV-RNA >5 log10 copies/mL, were included. The primary endpoint was treatment failure (TF), a composite endpoint defined as virological failure (VF, first of two consecutive HIV-RNA >50 copies/mL after 6 months of treatment), discontinuation of class of the anchor drug or death. Independent associations were investigated by Poisson regression analysis in a model including age, gender, mode of HIV transmission, CDC stage, HCV and HBV co-infection, pre-treatment HIV-RNA, CD4+ count and CD4+/CD8+ ratio, ongoing opportunistic disease, fibrosis FIB-4 index, estimated glomerular filtration rate, haemoglobin, platelets, neutrophils, calendar year of ART initiation, anchor drug class (treatment group) and nucleos(t)ide backbone. RESULTS: A total of 1195 patients fulfilled the inclusion criteria: 696 started ART with a bPI, 315 with an InSTI and 184 with an NNRTI. During 2759 person-years of follow up, 642 patients experienced TF. Starting ART with bPIs [adjusted incidence rate ratio (aIRR) (95% CI) 1.62 (1.29-2.03) versus starting with NNRTIs; P < 0.001] and starting ART with InSTIs [aIRR (95% CI) 0.68 (0.48-0.96) versus starting with NNRTIs; P = 0.03] were independently associated with TF. CONCLUSIONS: In patients starting ART with <200 CD4+ cells/mm3 and >5 log10 HIV-RNA copies/mL, the durability of regimens based on InSTIs was longer than that of NNRTI- and bPI-based regimens.
Authors: Thembi Mdluli; Yifan Li; Suteeraporn Pinyakorn; Daniel B Reeves; E Fabian Cardozo-Ojeda; Adam Yates; Jintana Intasan; Somporn Tipsuk; Nittaya Phanuphak; Carlo Sacdalan; Donn J Colby; Eugène Kroon; Trevor A Crowell; Rasmi Thomas; Merlin L Robb; Jintanat Ananworanich; Mark de Souza; Praphan Phanuphak; Daniel J Stieh; Frank L Tomaka; Lydie Trautmann; Julie A Ake; Denise C Hsu; Leilani V Francisco; Sandhya Vasan; Morgane Rolland Journal: Med (N Y) Date: 2022-07-22