Document Detail


Effect of persistency of first-line HIV antiretroviral therapy on clinical outcomes.
MedLine Citation:
PMID:  23151191     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Persistency is the time from initiation to discontinuation of therapy. Previous research has described factors that affect the persistency of initial antiretroviral therapy (ART); however, the impact of persistency on clinical outcomes is unknown. A retrospective study was conducted of treatment-naive HIV patients initiating ART between January 1, 2000 and December 31, 2010 at an academic medical center. Descriptive statistics and Cox proportional hazards regression models with persistency as a time-varying covariate were fit for (1) immunologic failure (subsequent CD4 lower than initial CD4); (2) development of an opportunistic infection (OI) or malignancy; and (3) mortality. Analyses were repeated with an interaction term of persistency (per 180 days) and time (before and after 1 year of ART). Among 879 patients who started ART, the mean age was 38 years (±10) and most patients were racial/ethnic minority (59%), males (80%), and with baseline CD4 <200 cells/mm(3) (52%). There were 100 deaths, 94 OIs/malignancy, and 183 immunologic failures; the mean persistency=723 days. In multivariable modeling, increased persistency decreased the overall and long-term hazard for immunologic failure (0.84 per 180 additional days; 0.70-1.00; 0.045). Increased persistency exhibited a potential trend toward decreased hazard for the occurrence of OI/malignancy (0.91; 0.80-1.03; 0.124) overall and after 1 year. Persistency exhibited a trend toward less risk of mortality in the first year of ART (0.42; 0.17-1.06; 0.067). In this study of the relationship between initial ART persistency and clinical outcomes, increased persistency was associated with a decreased hazard for the development of immunologic failure, a trend toward a decreased hazard for OI/malignancy, and a trend toward a decreased risk of first year mortality. Given these findings, the relationship between persistency and clinical outcomes merits further study.
Authors:
James H Willig; Andrew O Westfall; Michael Mugavero; Christa R Nevin; Todd Correll; Amit Duggal; William Guyer; Michael S Saag; Timothy Juday
Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-12-18
Journal Detail:
Title:  AIDS research and human retroviruses     Volume:  29     ISSN:  1931-8405     ISO Abbreviation:  AIDS Res. Hum. Retroviruses     Publication Date:  2013 Apr 
Date Detail:
Created Date:  2013-04-08     Completed Date:  2013-09-11     Revised Date:  2014-04-08    
Medline Journal Info:
Nlm Unique ID:  8709376     Medline TA:  AIDS Res Hum Retroviruses     Country:  United States    
Other Details:
Languages:  eng     Pagination:  698-703     Citation Subset:  IM; X    
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MeSH Terms
Descriptor/Qualifier:
AIDS-Related Opportunistic Infections / complications,  immunology
Adult
Anti-HIV Agents / administration & dosage,  therapeutic use*
CD4 Lymphocyte Count
Cohort Studies
Female
HIV Infections / complications,  drug therapy*,  immunology
Humans
Male
Middle Aged
Neoplasms / complications,  immunology
Proportional Hazards Models
Retrospective Studies
Time Factors
Treatment Outcome
Young Adult
Chemical
Reg. No./Substance:
0/Anti-HIV Agents
Comments/Corrections

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