Improved virologic outcomes over time for HIV-infected patients on antiretroviral therapy in a cohort from Rio de Janeiro, 1997–2011

Abstract

BackgroundPrevious cohort studies have demonstrated the beneficial effects of antiretroviral therapy (ART) on viral load suppression. We aimed to examine the factors associated with virologic suppression for HIV-infected patients on ART receiving care at the Evandro Chagas Clinical Research Institute, Oswaldo Cruz Foundation in Rio de Janeiro, Brazil.MethodsHIV-1 RNA levels and CD4+ T-cell counts at the date closest to midyear (1 July) were evaluated for 1,678 ART-naïve patients ≥18 years of age initiating ART between 1997 and 2010. The odds ratios (OR) and 95% confidence intervals (CI) for having an undetectable viral load (≤400 copies/mL) were estimated using generalized estimating equations regression models adjusted for clinical and demographic factors. Time-updated covariates included age, years since HIV diagnosis, hepatitis C diagnosis and ART interruptions.ResultsBetween 1997 and 2011, the proportion of patients with an undetectable viral load increased from 6% to 78% and the median [interquartile range] CD4+ T-cell count increased from 207 [162, 343] to 554 [382, 743] cells/μL. Pre-treatment median CD4+ T-cell count significantly increased over the observation period from 114 [37, 161] to 237 [76, 333] cells/μL (p < .001). The per-year adjusted OR (aOR) for having undetectable viral load was 1.18 (95% CI = 1.16-1.21). ART interruptions >1 month per calendar significantly decreased the odds [aOR = 0.32 (95% CI = 0.27-0.38)] of having an undetectable viral load. Patients initiating on a protease inhibitor (PI)-based first-line regimen were less likely to have undetectable viral load [aOR = 0.72 (95% CI = 0.63-0.83)] compared to those initiating on a non-nucleoside reverse transcriptase inhibitor (NNRTI)-based regimen.ConclusionsOur results demonstrate significant improvements in virologic outcomes from 1997 to 2011, which persisted after adjusting for other factors. This may in part be due to improvements in care and new treatment options. NNRTI- versus PI-based first-line regimens were found to be associated with increased odds of having an undetectable viral load, consistent with previous studies. Treatment interruptions were found to be the most important determinant of not having an undetectable viral load. Studies are needed to characterize the reasons for treatment interruptions and to develop subsequent strategies for improving adherence to ART.

Incidence of virological failure and major regimen change of initial combination antiretroviral therapy in the Latin America and the Caribbean: an observational cohort study

“…24,25 Compared with patients starting a zidovudine-containing regimen, those starting with stavudine were more likely to fail or switch regimens whereas those starting with tenofovir were less likely to fail or switch. These results may reflect non-adherence and poor tolerability due to toxicities; however, this study did not obtain information on medication adherence and reasons for switch of cART.…”

“…Virologic failure was also associated with initiating treatment in earlier calendar years, which is consistent with trends seen in other studies. 24,26,27 Improvements in efficacy and tolerability of antiretroviral agents, changes in clinical care such as increased clinician experience, and other unmeasured variables may be contributing to this trend. In contrast, incidence of major regimen change increased over time.…”

Perfis de mortalidade em pessoas vivendo com HIV/aids: comparação entre o Rio de Janeiro e as demais unidades da federação entre 1999 e 2015

“…Possible bottlenecks for reducing AIDS mortality in Rio de Janeiro include late presentation to clinical care for HIV -largely attributed to delayed diagnosis of infection and REV BRAS EPIDEMIOL 2020; 23: E200017 associated with increased risk of clinical events and progression to death, as well as reduction in the effectiveness of cART 23 .…”

Respuesta virológica e inmunológica a la terapia anti-retroviral en pacientes portadores de infección por VIH atendidos en una red de salud académica de Chile

“…Cabe destacar que en nuestro estudio, las mujeres alcanzaron similares recuentos de LT CD4+ que los hombres, lo que difiere de otras publicaciones 7 . Los pacientes alcanzaron carga viral indetectable (< 50 copias ARN/ml) en 86 y 80% de los casos a las 96 y 144 semanas, respectivamente, lo que es enteramente comparable e incluso superior a los resultados reportados por otros autores 3, [8][9][10][11][12] . En resumen, reportamos una excelente respuesta inmunológica y virológica a TARV en una cohorte de pacientes portadores de VIH atendidos en una Red de Salud académica con un seguimiento a 144 semanas.…”