Incidence of Modifying or Discontinuing First HAART Regimen and Its Determinants in a Cohort of HIV-Infected Patients from Rio de Janeiro, Brazil

Cardoso, Sandra Wagner; Grinsztejn, Beatriz; Velasque, Luciane; Veloso, Valdiléa G.; Luz, Paula M.; Friedman, Ruth Khalili; Morgado, Mariza G.; Ribeiro, Sayonara Rocha; Moreira, Ronaldo I.; Keruly, Jeanne C.; Moore, Richard D.

doi:10.1089/aid.2009.0274

Cited by 33 publications

(53 citation statements)

References 42 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Major adverse effect resulted in the regimen modification was lipodystrophy, followed by hepatotoxicity and rash in the study. Other studies in resource-limited settings showed the consistent results [6]-[8]. …”

Section: Introductionsupporting

confidence: 74%

“…In this study, time to regimen modification due to lipodystrophy was around three times longer than other studies [5],[6]. It might reflect the time lag between the diagnosis of lipodystrophy and regimen modification.…”

Section: Discussionmentioning

confidence: 57%

“…To our knowledge, only few observational studies comprehensively investigated predictors of ART regimen modification in clinical settings in low- and middle-income countries [6],[7],[15]. This study, therefore, aimed to examine the more recent incidence and predictors of regimen modification of the first-line ART in northern Thailand.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study

et al. 2014

View full text Add to dashboard Cite

BackgroundAntiretroviral therapy markedly reduced mortality in HIV-infected individuals. However, in the previous studies, up to 50% of patients are compelled to modify their regimen in middle and low-income countries where salvage drug is still limited. This cohort study aimed to investigate the incidence and predictors of regimen modification from the first-line antiretroviral regimen in northern Thailand.MethodsAll HIV-infected patients starting antiretroviral therapy (ART) with generic drug (GPOvir®; stavudine, lamivudine and nevirapine) at a governmental hospital in northern Thailand from 2002 to 2007 were recruited. Baseline characteristics and detailed information of regimen modification until the end of 2010 were ascertained from cohort database and medical charts. As a potential genetic predictor of regimen modification, HLA B allele was determined by bead-based array hybridization (WAKFlow® HLA typing kit). We investigated predictors of the regimen modification using Cox’s proportional hazard models.ResultsOf 979 patients, 914 were eligible for the analysis. The observed events of regimen modification was 377, corresponding to an incidence 13.8/100 person-year-observation (95% CI:12.5-15.3) over 2,728 person years (PY) follow up. The main reasons for regimen modification were adverse effects (73.5%), especially lipodystrophy (63.2%) followed by rash (17.7%). Sixty three patients (17.1%) changed the regimen due to treatment failure. 2% and 19% of patients had HLA-B*35:05 and B*4001, respectively. HLA-B*35:05 was independently associated with rash-related regimen modification (aHR 7.73, 95% CI:3.16-18.9) while female gender was associated with lipodystrophy (aHR 2.11, 95% CI:1.51-2.95). Female gender (aHR 0.54, 95% CI: 0.30-0.96), elder age (aHR 0.56, 95% CI: 0.32-0.99) and having HLA-B*40:01 (aHR 0.29, 95% CI: 0.10-0.82) were protective for treatment failure related modification.ConclusionHLA-B*35:05 and female gender were strong predictors of regimen modification due to rash and lipodystrophy, respectively. Female gender, elder age, and having HLA-B*40:01 had protective effects on treatment failure-related regimen modification. This study provides further information of regimen modification for future tailored ART in Asia.Electronic supplementary materialThe online version of this article (doi:10.1186/s12879-014-0565-5) contains supplementary material, which is available to authorized users.

show abstract

Section: Introductionsupporting

confidence: 74%

Section: Discussionmentioning

confidence: 57%

See 1 more Smart Citation

Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study

et al. 2014

View full text Add to dashboard Cite

show abstract

“…Given the importance of ART adherence to treatment efficacy [1], development of ART resistance [14], and mortality reduction [15], future research is needed to characterize the reasons for treatment interruptions [16]. …”

Section: Discussionmentioning

confidence: 99%

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

et al. 2014

Self Cite

View full text Add to dashboard Cite

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.

show abstract

“…An observational, longitudinal, clinical database is maintained on patients receiving primary and specialized outpatient and inpatient HIV care at the clinic; it includes socio-demographic, behavioral, clinical and therapeutic information. Details of the HIV/AIDS clinical cohort can be found elsewhere [7,8]. The IPEC Institutional Review Board reviewed and approved this study.…”

Section: Methodsmentioning

confidence: 99%

Effectiveness of first-line antiretroviral therapy in the IPEC cohort, Rio de Janeiro, Brazil

et al. 2014

Self Cite

View full text Add to dashboard Cite

BackgroundWhile Brazil has had a long-standing policy of free access to antiretroviral therapy (ART) for all in need, the epidemiological impact of ART on human immunodeficiency virus (HIV) RNA suppression in this middle-income country has not been well evaluated. We estimate first-line ART effectiveness in a large Brazilian cohort and examine the socio-demographic, behavioral, clinical and structural factors associated with virologic suppression.MethodsVirologic suppression on first-line ART at 6, 12, and 24 months from start of ART was defined as having a viral load measurement ≤400 copies/mL without drug class modification and/or discontinuation. Drug class modification and/or discontinuation were defined based on the class of a particular drug. Quasi-Poisson regression was used to quantify the association of factors with virologic suppression.ResultsFrom January 2000 through June 2010, 1311 patients started first-line ART; 987 (75%) patients used NNRTI-based regimens. Virologic suppression was achieved by 77%, 76% and 68% of patients at 6, 12 and 24 months, respectively. Factors associated with virologic suppression at 12 months were: >8 years of formal education (compared to <4 years, risk ratio (RR) 1.13, 95% confidence interval (95% CI) 1.03-1.24), starting ART in 2005-2010 (compared to 2000-2004, RR 1.25 95% CI 1.15-1.35), and clinical trial participation (compared to no participation, RR 1.08 95% CI 1.01-1.16). Also at 12 months, women showed less virologic suppression compared to heterosexual men (RR 0.90 95% CI 0.82-0.99). For the 24-month endpoint, in addition to higher education, starting ART in the later period, and clinical trial participation, older age and an NNRTI-based regimen were also independently associated with virologic suppression.ConclusionsOur results show that in Brazil, a middle-income country with free access to treatment, over three-quarters of patients receiving routine care reached virologic suppression on first-line ART by the end of the first year. Higher education, more recent ART initiation and clinical trial participation were associated with improved outcomes both for the 12-month and the 24-month endpoints, suggesting that further studies are needed to understand what aspects relating to these factors lead to higher virologic suppression.

show abstract

Incidence of Modifying or Discontinuing First HAART Regimen and Its Determinants in a Cohort of HIV-Infected Patients from Rio de Janeiro, Brazil

Cited by 33 publications

References 42 publications

Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study

Incidence and predictors of regimen-modification from first-line antiretroviral therapy in Thailand: a cohort study

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

Effectiveness of first-line antiretroviral therapy in the IPEC cohort, Rio de Janeiro, Brazil

Contact Info

Product

Resources

About