Long-Term Effectiveness of First-Line Antiretroviral Theraphy in a Cohort of HIV-1 Infected Patients
Jordi Navarro-Mercadé1*, Manuel Crespo1, Vicenç Falcó1, Eva Van Den Eynde1, Adrian Curran1, Joaquín Burgos1, Sara Villar Del Saz1, Estrella Caballero2, Imma Ocaña1, Mercè Perez-Bernal1, Esteban Ribera1 and Albert Pahissa1
- *Corresponding Author:
- Jordi Navarro-Mercadé
Servicio de Enfermedades Infecciosas
Paseo Vall d’Hebron 119-129
08035 Barcelona, Spain
E-mail: [email protected]
Received Date: March 06, 2012; Accepted Date: March 26, 2012; Published Date: March 28, 2012
Citation: Navarro-Mercadé J, Crespo M, Falcó V, Den Eynde EV, Curran A, et al. (2012) Long-Term Effectiveness of First-Line Antiretroviral Theraphy in a Cohort of HIV-1 Infected Patients. J Antivir Antiretrovir 4: 026-031. doi: 10.4172/jaa.1000042
Copyright: © 2012 Navarro-Mercadé J, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Background: Eligibility criteria might explain differences in viral response to combined antiretroviral treatment (cART) between clinical trials and routine care setting. Our aim was to assess the effectiveness of cART and factors associated to therapeutic failure (TF) in real clinical conditions.
Methods: A prospective cohort analysis including HIV-1 infected patients who started a cART between January 2004 and December 2009, at Vall d’Hebron Hospital. Effectiveness was evaluated as time to TF defined as the first of either virologic failure, treatment discontinuation whatever the reason other than switching, loss to follow-up, or death. The Kaplan-Meier method was used to estimate time-to-event distributions and Cox regression modelling to identify factors associated with TF.
Results: We analyzed 232 patients; median CD4+ cell count was 229 cells/mm3 and median viral load 4.89 log10. Almost a third of patients was co-infected with HCV and/or HBV. Tenofovir plus lamivudine/emtricitabine (67%) was the commonest backbone, and efavirenz (77%) the preferred third drug. The proportion of patients with no TF at month 12, 24 and 36 was 82.9%, 78.5% and 76% respectively. TF occurred in 57 (24.6%) patients, mainly due to intolerance or toxicity. The risk of TF was higher in patients starting cART before 2006 and in those with a protease inhibitor based regimen.
Conclusions: After a median follow-up of 36.5 months, three-fourth of patients who started first-line cART remained free of TF. Treatment discontinuation stands as the leading cause of TF.