Triple-class virologic failure in HIV-infected patients undergoing antiretroviral therapy for up to 10 years
Research output: Contribution to journal › Journal article › Research › peer-review
BACKGROUND: Life expectancy of people with human immunodeficiency virus (HIV) is now estimated to approach that of the general population in some successfully treated subgroups. However, to attain these life expectancies, viral suppression must be maintained for decades. METHODS: We studied the rate of triple-class virologic failure (TCVF) in patients within the Collaboration of Observational HIV Epidemiological Research Europe (COHERE) who started antiretroviral therapy (ART) that included a nonnucleoside reverse-transcriptase inhibitor (NNRTI) or a ritonavir-boosted protease inhibitor (PI/r) from 1998 onwards. We also focused on TCVF in patients who started a PI/r-containing regimen after a first-line NNRTI-containing regimen failed. RESULTS: Of 45 937 patients followed up for a median (interquartile range) of 3.0 (1.5-5.0) years, 980 developed TCVF (2.1%). By 5 and 9 years after starting ART, an estimated 3.4% (95% confidence interval [CI], 3.1%-3.6%) and 8.6% (95% CI, 7.5%-9.8%) of patients, respectively, had developed TCVF. The incidence of TCVF rose during the first 3 to 4 years on ART but plateaued thereafter. There was no significant difference in the risk of TCVF according to whether the initial regimen was NNRTI or PI/r based (P = .11). By 5 years after starting a PI/r regimen as second-line therapy, 46% of patients had developed TCVF. CONCLUSIONS: The rate of virologic failure of the 3 original drug classes is low, but not negligible, and does not appear to diminish over time from starting ART. If this trend continues, many patients are likely to need newer drugs to maintain viral suppression. The rate of TCVF from the start of a PI/r regimen after NNRTI failure provides a comparator for studies of response to second-line regimens in resource-limited settings.
Original language | English |
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Journal | Archives of Internal Medicine |
Volume | 170 |
Issue number | 5 |
Pages (from-to) | 410-9 |
Number of pages | 10 |
ISSN | 0003-9926 |
DOIs | |
Publication status | Published - 8 Mar 2010 |
Bibliographical note
Keywords: Adolescent; Adult; Anti-HIV Agents; Europe; Female; HIV Infections; HIV Protease Inhibitors; Humans; Kaplan-Meiers Estimate; Life Expectancy; Male; Middle Aged; Proportional Hazards Models; Reverse Transcriptase Inhibitors; Ritonavir; Treatment Failure; Viral Load; Young Adult
ID: 20570893