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Publication

Author(s):

Althoff KN, Justice AC, Gange SJ, Deeks SG, Saag MS, Silverberg MJ, Gill MJ, Lau B, Napravnik S, Tedaldi E, Klein MB, Gebo KA; North American AIDS Cohorts Collaboration on Research, Design (NA-ACCORD).

Pub Title:

Virologic and immunologic response to HAART, by age and regimen class.

Pub Date:

Oct 23 2010

Journal Issue:

24

Page Number:
2469-2479

Journal:

Title: 
AIDS
Link: 
http://journals.lww.com/aidsonline/pages/articleviewer.aspx?year=2010&issue=10230&article=00006&type=abstract

PubMed: 20829678
Pub PDF: PDF icon 20829678.pdf

Abstract
OBJECTIVE
: To determine the impact of age and initial HAART regimen class on virologic and immunologic response within 24 months after initiation.

DESIGN: Pooled analysis of data from 19 prospective cohort studies in the North American AIDS Cohort Collaboration on Research and Design (NA-ACCORD).

METHODS: Twelve thousand, one hundred and ninety-six antiretroviral-naive adults who initiated HAART between 1998 and 2008 using a boosted protease inhibitor-based regimen or a nonnucleoside reverse transcriptase inhibitor (NNRTI)-based regimen were included in our study. Discrete time-to-event models estimated adjusted hazard odds ratios (aHOR) and 95% confidence intervals (CIs) for suppressed viral load (≤500 copies/ml) and, separately, at least 100 cells/μl increase in CD4 cell count. Truncated, stabilized inverse probability weights accounted for selection biases from discontinuation of initial regimen class.

RESULTS: Among 12 196 eligible participants (mean age = 42 years), 50% changed regimen classes after initiation (57 and 48% of whom initiated protease inhibitor and NNRTI-based regimens, respectively). Mean CD4 cell count at initiation was similar by age. Virologic response to treatment was less likely in those initiating using a boosted protease inhibitor [aHOR = 0.77 (0.73, 0.82)], regardless of age. Immunologic response decreased with increasing age [18-<30: ref; 30-<40: aHOR = 0.92 (0.85, 1.00); 40-<50: aHOR = 0.85 (0.78, 0.92); 50-<60: aHOR = 0.82 (0.74, 0.90); ≥60: aHOR = 0.74 (0.65, 0.85)], regardless of initial regimen.

CONCLUSION: We found no evidence of an interaction between age and initial antiretroviral regimen on virologic or immunologic response to HAART; however, decreased immunologic response with increasing age may have implications for age-specific when-to-start guidelines.

PMID: 20829678 [PubMed - indexed for MEDLINE]

PMCID: PMC3136814

 

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Citation:

Althoff KN, Justice AC, Gange SJ, Deeks SG, Saag MS, Silverberg MJ, Gill MJ, Lau B, Napravnik S, Tedaldi E, Klein MB, Gebo KA; North American AIDS Cohorts Collaboration on Research, Design (NA-ACCORD). Virologic and immunologic response to HAART, by age and regimen class. AIDS. 2010 Oct 23;24(16):2469-79. doi: 10.1097/QAD.0b013e32833e6d14. Erratum in: AIDS.2011 Jan 28;25(3):397. PubMed PMID: 20829678; PubMed Central PMCID: PMC3136814.