1. Does short-term virologic failure translate to clinical events in antiretroviral-naïve patients initiating antiretroviral therapy in clinical practice?: VF & Clinical Events by ART Regimen
- Author
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Mugavero, Michael, May, Margaret, Harris, Ross, Saag, Michael, Costagliola, Dominique, Egger, Matthias, Phillips, Andrew, Günthard, Huldrych, Dabis, Francois, Hogg, Robert, De Wolf, Frank, Fatkenheuer, Gerd, John Gill, M., Justice, Amy, D'Arminio Monforte, Antonella, Lampe, Fiona, Miró, Jose, Staszewski, Schlomo, Sterne, Jonathan, Division of Infectious Disease, University of Alabama at Birmingham [ Birmingham] (UAB), Department of Social Medicine, University of Bristol [Bristol], Desmond Tutu HIV Centre, University of Cape Town-Institute of Infectious Disease and Molecular Medicine, Epidémiologie Clinique et Traitement de l'Infection à VIH, Université Pierre et Marie Curie - Paris 6 (UPMC)-IFR113-Institut National de la Santé et de la Recherche Médicale (INSERM), Institute of Social and Preventive Medicine, University of Berne, Department of Primary Care and Population Sciences, Royal Free and University College Medical School, Divison of Infectious Diseases and Hospital Epidemiology, University hospital of Zurich [Zurich], Epidémiologie, santé publique et développement, Université Bordeaux Segalen - Bordeaux 2-Institut National de la Santé et de la Recherche Médicale (INSERM)-IFR99-ISPED, Division of Epidemiology and Population Health, British Columbia Centre for Excellence in HIV/AIDS, Academisch Medisch Centrum bij, Universiteit van Amsterdam (UvA), Department of Internal Medicine, University of Cologne, Division of Infectious Diseases, University of Calgary, Yale University School of Medicine, Clinic of Infectious Diseases & Tropical Medicine, 'San Paolo' Hospital-University of Milan, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona (UB), Zentrum der Inneren Medizin, Goethe-Universität Frankfurt am Main, Universität Bern [Bern] (UNIBE), Yale School of Medicine [New Haven, Connecticut] (YSM), and Università degli Studi di Milano = University of Milan (UNIMI)-'San Paolo' Hospital
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AIDS ,virus diseases ,HIV ,Antiretroviral Therapy ,Highly Active ,Viral load ,[SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie ,Cohort analysis ,AIDS-related Opportunistic Infections ,Mortality - Abstract
International audience; OBJECTIVE: To determine whether differences in short-term virologic failure among commonly used antiretroviral therapy (ART) regimens translate to differences in clinical events in antiretroviral-na? patients initiating ART. DESIGN: Observational cohort study of patients initiating ART between January 2000 and December 2005. SETTING: The Antiretroviral Therapy Cohort Collaboration (ART-CC) is a collaboration of 15 HIV cohort studies from Canada, Europe, and the United States. STUDY PARTICIPANTS: A total of 13 546 antiretroviral-na? HIV-positive patients initiating ART with efavirenz, nevirapine, lopinavir/ritonavir, nelfinavir, or abacavir as third drugs in combination with a zidovudine and lamivudine nucleoside reverse transcriptase inhibitor backbone. MAIN OUTCOME MEASURES: Short-term (24-week) virologic failure (>500 copies/ml) and clinical events within 2 years of ART initiation (incident AIDS-defining event, death, and a composite measure of these two outcomes). RESULTS: Compared with efavirenz as initial third drug, short-term virologic failure was more common with all other third drugs evaluated; nevirapine (adjusted odds ratio = 1.87, 95% confidence interval (CI) = 1.58-2.22), lopinavir/ritonavir (1.32, 95% CI = 1.12-1.57), nelfinavir (3.20, 95% CI = 2.74-3.74), and abacavir (2.13, 95% CI = 1.82-2.50). However, the rate of clinical events within 2 years of ART initiation appeared higher only with nevirapine (adjusted hazard ratio for composite outcome measure 1.27, 95% CI = 1.04-1.56) and abacavir (1.22, 95% CI = 1.00-1.48). CONCLUSION: Among antiretroviral-na? patients initiating therapy, between-ART regimen, differences in short-term virologic failure do not necessarily translate to differences in clinical outcomes. Our results should be interpreted with caution because of the possibility of residual confounding by indication.
- Published
- 2008
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