Background There are no data comparing the response to PI/r-based regimens in people presenting for care with low CD4 counts or AIDS (LC). Aim To compare the response to LPV/r-, DRV/r- or ATV/r-based cART regimens in LC initiating cART from ART-naive. Methods We included people enrolled in Icona with either CD4 counts ≤350 cells/mm3 (low CD4-LC) or CD4 counts ≤200 cells/mm3 (very low CD4-VLC) and/or AIDS, starting their first PI/rbased regimen after 2008. Initial regimens were compared by intention-to-treat: i) time to viral failure (VF) (first of 2 consecutive VL>200 copies/mL after ≥6 months); II) time to PI/r discontinuation/switching for any cause (TD) and for toxicity (TDT); III) treatment failure (TF) (VF or TD). Kaplan-Meier and Cox analyses were used. Results 1,362 LC patients were included (DRV/r 607; ATV/r 552; LPV/r 203); 813 VLC. In a median of 18 months (IQR:7-35), the 1-year probability of VF and TF were 2.8% (1.9-3.8) and 21.1% (18.7-23.4). In the adjusted analysis, patients initiating ATV/r had a 53% lower chance, and those initiating DRV/r a 61% lower chance of TD, as compared to LPV/r; the risk of TF was more likely in people starting LPV/r. Results were similar among VLC; in this subgroup LPV/r including regimens demonstrated a lower chance of VF. Conclusions We confirmed in LC a low chance of virological failure by 1 year, with small differences according to PI/r. However, larger differences were observed when comparing longer-term endpoints such as treatment failure. These results are important for people presenting late for care.

D'Arminio Monforte, A., Cozzi-Lepri, A., Maggiolo, F., Rizzardini, G., Manconi, P., Gianotti, N., et al. (2016). Response to first-line ritonavir-boosted protease inhibitors (PI/r)-based regimens in HIV positive patients presenting to care with low CD4 counts: Data from the Icona Foundation Cohort. PLOS ONE, 11(6) [10.1371/journal.pone.0156360].

Response to first-line ritonavir-boosted protease inhibitors (PI/r)-based regimens in HIV positive patients presenting to care with low CD4 counts: Data from the Icona Foundation Cohort

Puoti M.
Membro del Collaboration Group
;
Bonfanti P.
Membro del Collaboration Group
;
Lapadula G.
Membro del Collaboration Group
;
2016

Abstract

Background There are no data comparing the response to PI/r-based regimens in people presenting for care with low CD4 counts or AIDS (LC). Aim To compare the response to LPV/r-, DRV/r- or ATV/r-based cART regimens in LC initiating cART from ART-naive. Methods We included people enrolled in Icona with either CD4 counts ≤350 cells/mm3 (low CD4-LC) or CD4 counts ≤200 cells/mm3 (very low CD4-VLC) and/or AIDS, starting their first PI/rbased regimen after 2008. Initial regimens were compared by intention-to-treat: i) time to viral failure (VF) (first of 2 consecutive VL>200 copies/mL after ≥6 months); II) time to PI/r discontinuation/switching for any cause (TD) and for toxicity (TDT); III) treatment failure (TF) (VF or TD). Kaplan-Meier and Cox analyses were used. Results 1,362 LC patients were included (DRV/r 607; ATV/r 552; LPV/r 203); 813 VLC. In a median of 18 months (IQR:7-35), the 1-year probability of VF and TF were 2.8% (1.9-3.8) and 21.1% (18.7-23.4). In the adjusted analysis, patients initiating ATV/r had a 53% lower chance, and those initiating DRV/r a 61% lower chance of TD, as compared to LPV/r; the risk of TF was more likely in people starting LPV/r. Results were similar among VLC; in this subgroup LPV/r including regimens demonstrated a lower chance of VF. Conclusions We confirmed in LC a low chance of virological failure by 1 year, with small differences according to PI/r. However, larger differences were observed when comparing longer-term endpoints such as treatment failure. These results are important for people presenting late for care.
Articolo in rivista - Articolo scientifico
Adult; Anti-HIV Agents; CD4-Positive T-Lymphocytes; Female; HIV Protease Inhibitors; HIV Seropositivity; Humans; Lymphocyte Count; Male; Ritonavir;
English
Puoti, Bonfanti e Lapadula Icona Foundation Study cohort
D'Arminio Monforte, A., Cozzi-Lepri, A., Maggiolo, F., Rizzardini, G., Manconi, P., Gianotti, N., et al. (2016). Response to first-line ritonavir-boosted protease inhibitors (PI/r)-based regimens in HIV positive patients presenting to care with low CD4 counts: Data from the Icona Foundation Cohort. PLOS ONE, 11(6) [10.1371/journal.pone.0156360].
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/10281/388107
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