Characterization and outcomes of difficult-to-treat patients starting modern first-line ART regimens : Data from the ICONA cohort
Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved..
OBJECTIVES: Treatment failures to modern antiretroviral therapy (ART) raise concerns, as they could reduce future options. Evaluations of occurrence of multiple failures to modern ART are missing and their significance in the long run is unclear.
METHODS: People with HIV (PWH) in the ICONA cohort who started a modern first-line ART were defined as 'difficult to treat' (DTT) if they experienced ≥1 among: i) ≥2 VF (2 viral loads, VL>200 copies/mL or 1 VL>1000 copies/mL) with or without ART change; ii) ≥2 treatment discontinuations (TD) due to toxicity/intolerance/failure; iii) ≥1 VF followed by ART change plus ≥1 TD due to toxicity/intolerance/failure. A subgroup of the DTT participants were matched to PWH that, after the same time, were non-DTT. Treatment response, analysing VF, TD, treatment failure, AIDS/death, and SNAE (Serious non-AIDS event)/death, were compared. Survival analysis by KM curves and Cox regression models were employed.
RESULTS: Among 8061 PWH, 320 (4%) became DTT. Estimates of becoming DTT was 6.5% (95% CI: 5.8-7.4%) by 6 years. DTT PWH were significantly older, with a higher prevalence of AIDS and lower CD4+ at nadir than the non-DTT. In the prospective analysis, DTT demonstrated a higher unadjusted risk for all the outcomes. Once controlled for confounders, significant associations were confirmed for VF (aHR 2.23, 1.33-3.73), treatment failure (aHR 1.70, 1.03-2.78), and SNAE/death (aHR 2.79, 1.18-6.61).
CONCLUSION: A total of 6.5% of PWH satisfied our definition of DTT by 6 years from ART starting. This appears to be a more fragile group who may have higher risk of failure.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:63 |
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| Enthalten in: |
International journal of antimicrobial agents - 63(2024), 1 vom: 12. Jan., Seite 107018 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Gagliardini, Roberta [VerfasserIn] |
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| Links: |
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| Themen: |
ART |
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| Anmerkungen: |
Date Completed 15.01.2024 Date Revised 15.01.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1016/j.ijantimicag.2023.107018 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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NLM367047985 |
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| 100 | 1 | |a Gagliardini, Roberta |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Characterization and outcomes of difficult-to-treat patients starting modern first-line ART regimens |b Data from the ICONA cohort |
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| 500 | |a Date Completed 15.01.2024 | ||
| 500 | |a Date Revised 15.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a Copyright © 2023 The Author(s). Published by Elsevier Ltd.. All rights reserved. | ||
| 520 | |a OBJECTIVES: Treatment failures to modern antiretroviral therapy (ART) raise concerns, as they could reduce future options. Evaluations of occurrence of multiple failures to modern ART are missing and their significance in the long run is unclear | ||
| 520 | |a METHODS: People with HIV (PWH) in the ICONA cohort who started a modern first-line ART were defined as 'difficult to treat' (DTT) if they experienced ≥1 among: i) ≥2 VF (2 viral loads, VL>200 copies/mL or 1 VL>1000 copies/mL) with or without ART change; ii) ≥2 treatment discontinuations (TD) due to toxicity/intolerance/failure; iii) ≥1 VF followed by ART change plus ≥1 TD due to toxicity/intolerance/failure. A subgroup of the DTT participants were matched to PWH that, after the same time, were non-DTT. Treatment response, analysing VF, TD, treatment failure, AIDS/death, and SNAE (Serious non-AIDS event)/death, were compared. Survival analysis by KM curves and Cox regression models were employed | ||
| 520 | |a RESULTS: Among 8061 PWH, 320 (4%) became DTT. Estimates of becoming DTT was 6.5% (95% CI: 5.8-7.4%) by 6 years. DTT PWH were significantly older, with a higher prevalence of AIDS and lower CD4+ at nadir than the non-DTT. In the prospective analysis, DTT demonstrated a higher unadjusted risk for all the outcomes. Once controlled for confounders, significant associations were confirmed for VF (aHR 2.23, 1.33-3.73), treatment failure (aHR 1.70, 1.03-2.78), and SNAE/death (aHR 2.79, 1.18-6.61) | ||
| 520 | |a CONCLUSION: A total of 6.5% of PWH satisfied our definition of DTT by 6 years from ART starting. This appears to be a more fragile group who may have higher risk of failure | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a ART | |
| 650 | 4 | |a Late presenters | |
| 650 | 4 | |a Treatment discontinuations | |
| 650 | 4 | |a Treatment failures | |
| 650 | 4 | |a Virological failure | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 700 | 1 | |a Tavelli, Alessandro |e verfasserin |4 aut | |
| 700 | 1 | |a Rusconi, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Lo Caputo, Sergio |e verfasserin |4 aut | |
| 700 | 1 | |a Spagnuolo, Vincenzo |e verfasserin |4 aut | |
| 700 | 1 | |a Santoro, Maria Mercedes |e verfasserin |4 aut | |
| 700 | 1 | |a Costantini, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Vergori, Alessandra |e verfasserin |4 aut | |
| 700 | 1 | |a Maggiolo, Franco |e verfasserin |4 aut | |
| 700 | 1 | |a Giacomelli, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Burastero, Giulia |e verfasserin |4 aut | |
| 700 | 1 | |a Madeddu, Giordano |e verfasserin |4 aut | |
| 700 | 1 | |a Quiros Roldan, Eugenia |e verfasserin |4 aut | |
| 700 | 1 | |a d'Arminio Monforte, Antonella |e verfasserin |4 aut | |
| 700 | 1 | |a Antinori, Andrea |e verfasserin |4 aut | |
| 700 | 1 | |a Cozzi-Lepri, Alessandro |e verfasserin |4 aut | |
| 700 | 0 | |a ICONA Foundation Study Group |e verfasserin |4 aut | |
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