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No advantage of quadruple or triple-class antiretroviral therapy as initial treatment in patients with very high viraemia.
MedLine Citation:
PMID:  22909444     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
Background We assessed whether quadruple or triple-class therapy for the initial treatment of HIV-1 infection provides a virological benefit over standard triple therapy in patients with a very high plasma viraemia.Design National observational HIV cohort in the Netherlands.Methods Inclusion criteria were age ≥18 years, treatment-naïve, plasma viral load (pVL) ≥500.000 copies/ml and initiation of quadruple or triple therapy between 2001-2011. Time to viral suppression, defined as pVL <50 c/ml, was compared between the two groups using Kaplan-Meier plots and multivariate Cox regression analysis.Results 675 patients were included: 125 (19%) initiated quadruple and 550 (81%) triple therapy. Median pVL was 5.9 (IQR 5.8-6.1) log(10) c/ml in both groups (P=0.49). 22 (18%) patients on quadruple and 63 (12%) on triple therapy interrupted the treatment regimen because of drug-related toxicity (P=0.06). Median time to viral suppression was 5.8 (IQR 4.6-7.9) and 6.0 (4.0-9.4) months in the patients on quadruple and triple therapy (log rank, P=0.42). In the adjusted Cox analysis, quadruple therapy was not associated with time to viral suppression (HR 1.07 (95% CI 0.86-1.33), P=0.53). Similar results were seen when comparing triple- versus dual-class therapy (n=72 vs. n=601, respectively).Conclusions Initial quadruple or triple-class therapy was equally effective as standard triple therapy in the suppression of HIV-1 in treatment-naïve patients with very high viraemia and did not result in a faster pVL decline, but did expose patients to additional toxicity.
Authors:
Marlous L Grijsen; Rebecca Holman; Luuk Gras; Ferdinand Wnm Wit; Andy Im Hoepelman; Guido E van den Berk; Frank de Wolf; Jan M Prins;
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2012-8-20
Journal Detail:
Title:  Antiviral therapy     Volume:  -     ISSN:  2040-2058     ISO Abbreviation:  Antivir. Ther. (Lond.)     Publication Date:  2012 Aug 
Date Detail:
Created Date:  2012-8-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9815705     Medline TA:  Antivir Ther     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Academic Medical Center, University of Amsterdam, Department of Internal Medicine, Division of Infectious Diseases, Center for Infection and Immunity Amsterdam, Amsterdam, the Netherlands. m.l.grijsen@amc.uva.nl.
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