Discontinuation of Initial Antiretroviral Therapy in Clinical Practice

Biagio, Antonio Di; Cozzi‐Lepri, Alessandro; Prinapori, Roberta; Angarano, Gioacchino; Gori, Andrea; Quirino, Tiziana; Luca, Andrea De; Costantini, Andrea; Mussini, Cristina; Rizzardini, Giuliano; Castagna, Antonella; Antinori, Andrea; Monforte, Antonella d’Arminio

doi:10.1097/qai.0000000000000849

Cited by 39 publications

(37 citation statements)

References 42 publications

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“…Firstly, for patients in the UK, discontinuation of initial treatment is not an uncommon event. The discontinuation rate of third agent and NRTI backbone of 28 (95% CI 26–31) and 15 (95% CI 14–17) per hundred person-years respectively are comparable to those seen in other high-income settings: in an Italian cohort of 4052 patients starting ART between 2008 and 2014, discontinuation rates at 1,2 and 3 years were 26%,40% and 49%, respectively 8 . These are similar to data from British Columbia, Canada, where the ART discontinuation rates of 2107 patients who initiated therapy between 2006 and 2010 were 36%, 47% and 53% at 1, 2 and 3 years, 9 and Switzerland, where the rate of discontinuation of initial treatment in 1318 treatment-naïve patients was 42 per 100 person-years (95% CI 38–46) 10 .…”

Section: Discussionsupporting

confidence: 64%

Real-world persistence with antiretroviral therapy for HIV in the United Kingdom: A multicentre retrospective cohort study

Lewis

Smith

Torkington

et al. 2017

Journal of Infection

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SummaryObjectivesPersistence with an antiretroviral therapy (ART) regimen for HIV can be defined as the length of time a patient remains on therapy before stopping or switching. We aimed to describe ART persistence in treatment naïve patients starting therapy in the United Kingdom, and to describe differential persistence by treatment regimen.MethodsWe performed a retrospective cohort study at eight UK centres of ART-naïve adults commencing ART between 2012 and 2015. Aggregate data were extracted from local treatment databases. Time to discontinuation was compared for different third agents and NRTI backbones using incidence rates.Results1949 patients contributed data to the analysis. Rate of third agent change was 28 per 100 person-years of follow up [95% CI 26–31] and NRTI backbone change of 15 per 100 person-years of follow up [95% CI 14–17]). Rilpivirine, as co-formulated rilpivirine/tenofovir/emtricitabine had a significantly lower discontinuation rate than all other third agents and, excluding single tablet regimens, co-formulated tenofovir/emtricitabine had a significantly lower discontinuation rate than co-formulated abacavir/lamivudine. The reasons for discontinuation were not well recorded.ConclusionsTreatment discontinuation is not an uncommon event. Rilpivirine had a significantly lower discontinuation rate than other third agents and tenofovir/emtricitabine a lower rate than co-formulated abacavir/lamivudine.

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Section: Discussionsupporting

confidence: 64%

Real-world persistence with antiretroviral therapy for HIV in the United Kingdom: A multicentre retrospective cohort study

Lewis

Smith

Torkington

et al. 2017

Journal of Infection

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“…These findings have high clinical relevance, as NNRTIs are a widely used class of antiretroviral agent even in ART‐naïve patients , and combinations of two nucleoside reverse transcriptase inhibitors (NRTIs) plus an NNRTI have previously been reported to have high durability , although recent data demonstrate an even better performance of INSTI‐based regimens . EFV was for years the preferred third agent, in international guidelines at least until 2013 , and in Italian guidelines until 2014 , and is still a preferred choice for first‐line cART according to the World Health Organization (WHO) .…”

Section: Discussionmentioning

confidence: 94%

First‐line antiretroviral therapy with efavirenz plus tenofovir disiproxil fumarate/emtricitabine or rilpivirine plus tenofovir disiproxil fumarate/emtricitabine: a durability comparison

Taramasso¹,

Biagio²,

Maggiolo³

et al. 2018

HIV Medicine

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“…Besides, the intolerable side effects of HIV medications can emanate from failure due to drug-drug interactions, organ specific toxicity and/or non-adherence (35). In other to mitigate some of the unwanted side effects of HAART, PLWHAs in sub-Saharan Africa rely on medicinal plants rich in biologically active components for alleviation of some of the toxicities of HAART (36).…”

Section: Discussionmentioning

confidence: 99%

Coconut Oil Extract Mitigates Testicular Injury Following Adjuvant Treatment with Antiretroviral Drugs

et al. 2016

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Increased access to highly active antiretroviral therapy (HAART) has made the management of drug toxicities an increasingly crucial component of HIV. This study investigated the effects of adjuvant use of coconut oil and HAART on testicular morphology and seminal parameters in Sprague- Dawley rats. Twelve adult male Sprague-Dawley rats, weighing 153~169 g were distributed into four groups (A–D) and treated as follows: A served as control (distilled water); B (HAART cocktail- Zidovudine, Lamivudine and Nevirapine); C (HAART + Virgin coconut oil 10 mL/kg) and D (Virgin coconut oil 10 mL/kg). After 56 days of treatment, animals were killed and laparotomy to exercise the epididymis for seminal fluid analyses done whilst testicular tissues were processed for histomorphometric studies. Result showed a significant decline in sperm motility (P < 0.05) and count (P < 0.0001) in HAART-treated animals while there was insignificant changes in other parameters in groups C and D except count that was reduced (P < 0.0001) when compared with controls. Histomorphological studies showed HAART caused disorders in seminiferous tubular architecture with significant (P < 0.01) decline in epithelial height closely mirrored by extensive reticulin framework and positive PAS cells. Adjuvant Virgin coconut oil + HAART resulted in significant decrease in seminiferous tubular diameter (P < 0.05), but other morphometric and histological parameters were similar to control or Virgin coconut oil alone (which showed normal histoarchitecture levels). While derangements in testicular and seminal fluid parameters occurred following HAART, adjuvant treatment with Virgin coconut oil restored the distortions emanating thereof.

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Discontinuation of Initial Antiretroviral Therapy in Clinical Practice

Abstract: Supplemental Digital Content is Available in the Text.

Cited by 39 publications

References 42 publications

Real-world persistence with antiretroviral therapy for HIV in the United Kingdom: A multicentre retrospective cohort study

Real-world persistence with antiretroviral therapy for HIV in the United Kingdom: A multicentre retrospective cohort study

First‐line antiretroviral therapy with efavirenz plus tenofovir disiproxil fumarate/emtricitabine or rilpivirine plus tenofovir disiproxil fumarate/emtricitabine: a durability comparison

Coconut Oil Extract Mitigates Testicular Injury Following Adjuvant Treatment with Antiretroviral Drugs

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