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Home >> Publications >> Clinical and Virologic Outcomes After Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network.

Publication

Author(s):

Wolff M, Shepherd BE, Cortés C, Rebeiro P, Cesar C, Wagner Cardoso S, Pape JW, Padgett D, Sierra-Madero J, Echevarria J, McGowan CC; Caribbean, Central and South America Network for HIV Epidemiology (CCASAnet).

Pub Title:

Clinical and Virologic Outcomes After Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network.

Pub Date:

Jan 1 2016

Page Number:
102-10

Journal:

Title: 
JAIDS- Journal of Acquired Immune Deficiency Syndromes
Link: 
http://ovidsp.tx.ovid.com/sp-3.18.0b/ovidweb.cgi?QS2=434f4e1a73d37e8c59ef91306b1fac615b8947f0893ac45cba99a1446fc20c7bacd5eb7c767f7ee3b9adcff8c35254b4a0889d9ecb7fc30af9049723ed1309ae63d1a926570431b30d4fa4408cbcaaf953876b0125cc11b1792cbf6329ed02d521f3946189

PubMed: 26761273
BACKGROUND:
HIV-infected persons in resource-limited settings may experience high rates of antiretroviral therapy (ART) change, particularly because of toxicity or other nonfailure reasons. Few reports address patient outcomes after these modifications.
METHODS:
HIV-infected adults from the 7 Caribbean, Central and South America network clinical cohorts who modified >1 drug from the first ART regimen (ART-1) for any reason thereby starting a second regimen (ART-2) were included. We assessed cumulative incidence of, and factors associated with, death, virologic failure (VF), and regimen change after starting ART-2.
RESULTS:
Five thousand five hundred sixty-five ART-naive highly active ART initiators started ART-2 after a median of 9.8 months on ART-1; 39% changed to ART-2 because of toxicity and 11% because of failure. Median follow-up after starting ART-2 was 2.9 years; 45% subsequently modified ART-2. Cumulative incidences of death at 1, 3, and 5 years after starting ART-2 were 5.1%, 8.4%, and 10.5%, respectively. In adjusted analyses, death was associated with older age, clinical AIDS, lower CD4 at ART-2 start, earlier calendar year, and starting ART-2 because of toxicity (adjusted hazard ratio = 1.5 vs. failure, 95% confidence interval: 1.0 to 2.1). Cumulative incidences of VF after 1, 3, and 5 years were 9%, 19%, and 25%. In adjusted analyses, VF was associated with younger age, earlier calendar year, lower CD4 at the start of ART-2, and starting ART-2 because of failure (adjusted hazard ratio = 2.1 vs. toxicity, 95% confidence interval: 1.5 to 2.8).
CONCLUSIONS:
Among patients modifying the first ART regimen, risks of subsequent modifications, mortality, and virologic failure were high. Access to improved antiretrovirals in the region is needed to improve initial treatment success.

 

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Citation:

Wolff M, Shepherd BE, Cortés C, Rebeiro P, Cesar C, Wagner Cardoso S, Pape JW, Padgett D, Sierra-Madero J, Echevarria J, et al. Clinical and Virologic Outcomes After Changes in First Antiretroviral Regimen at 7 Sites in the Caribbean, Central and South America Network. J Acquir Immune Defic Syndr. 2016 Jan 1;71(1):102-10. doi: 10.1097/QAI.0000000000000817. PubMed PMID: 26761273; PubMed Central PMCID: PMC4712722.