| Effect of persistency of first-line HIV antiretroviral therapy on clinical outcomes. | |
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MedLine Citation:
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PMID: 23151191 Owner: NLM Status: Publisher |
Abstract/OtherAbstract:
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Introduction: 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. Methods: Retrospective study of treatment naïve HIV patients initiating ART between 1/1/00 and 12/31/10 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; (3) mortality. Analyses were repeated with an interaction term of persistency (per 180 days) and time (before and after 1 year of ART). Results: Among 879 patients who started ART, mean age was 38 years (±10) and most patients were racial/ethnic minority (59%), males (80%), with baseline CD4<200 cells/mm3 (52%). There were 100 deaths, 94 OIs / malignancy, and 183 immunologic failures; mean persistency = 723 days. In multi-variable 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 towards decreased hazard for occurrence of OI/malignancy (0.91; 0.80-1.03; 0.124) overall and after 1 year. Persistency exhibited a trend towards less risk of mortality in the first year of ART (0.42; 0.17-1.06; 0.067). Discussion: 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 towards a decreased hazard for OI/malignancy and a trend towards a decreased risk of first year mortality. Given these findings, the relationship between persistency and clinical outcomes merits further study. |
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Authors:
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James H Willig; Andrew Westfall; Michael J Mugavero; Christa R Nevin; Todd Correll; Amit Duggal; William Guyer; Michael Saag; Timothy Juday |
Publication Detail:
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Type: JOURNAL ARTICLE Date: 2012-11-15 |
Journal Detail:
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Title: AIDS research and human retroviruses Volume: - ISSN: 1931-8405 ISO Abbreviation: AIDS Res. Hum. Retroviruses Publication Date: 2012 Nov |
Date Detail:
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Created Date: 2012-11-15 Completed Date: - Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 8709376 Medline TA: AIDS Res Hum Retroviruses Country: - |
Other Details:
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Languages: ENG Pagination: - Citation Subset: - |
Affiliation:
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University of Alabama at Birmingham, Medicine- Infectious Diseases, CCB 178, 908 20th Street South, Birmingham, Alabama, United States, 35294-2050; jwillig@uab.edu. |
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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