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Author Notes:

Corresponding Author: Anandi N. Sheth, MD, 49 Jesse Hill Junior Drive, Atlanta, Georgia 30303, Phone: (404) 616-6240, Fax: (404) 616-0592, ansheth@emory.edu.

A.N.S. wrote the manuscript and contributed to study design and data analysis.

I.O., K.B., C.A., J.S.C., R.H., J.T.B., and F.J.P. contributed to study design, data analysis, and manuscript editing.

R.B. contributed to data analysis and manuscript editing.

For acknowledgements, please see the full article.

Disclaimer: The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

Subjects:

Research Funding:

Financial support was received from the Centers for Disease Control and Prevention (contracts 200-2001-00133, 200-2006-18797, and 200-2011-41872) and the National Center for Advancing Translational Sciences of the National Institutes of Health (KL2TR000455 and UL1TR000454).

Keywords:

  • Science & Technology
  • Life Sciences & Biomedicine
  • Immunology
  • Infectious Diseases
  • antiretroviral therapy
  • durability
  • cohort study
  • THERAPY REGIMENS
  • DISCONTINUATION
  • INFECTION
  • ADHERENCE
  • DURATION
  • REASONS

Antiretroviral Regimen Durability and Success in Treatment-Naive and Treatment-Experienced Patients by Year of Treatment Initiation, United States, 1996-2011

Tools:

Journal Title:

Journal of Acquired Immune Deficiency Syndromes

Volume:

Volume 71, Number 1

Publisher:

, Pages 47-56

Type of Work:

Article | Post-print: After Peer Review

Abstract:

Background: Although modern combination antiretroviral therapy (cART) regimens are better tolerated and less complex than earlier treatments, regimen modification or discontinuation remains a concern. Methods: We studied HIV Outpatient Study (HOPS) participants who initiated first or second cART regimens during: 1996–1999, 2000–2003, 2004–2007 and 2008–2011. We analyzed regimen durability (time to regimen modification) and success (achieving undetectable plasma HIV RNA) for first and second cART regimens using Kaplan-Meier curves and log-rank tests, and examined factors associated with durability and success of first cART regimen using proportional hazards models. Results: Durability of cART was progressively longer for cART regimens initiated in more recent periods: median first cART regimen durations were 1.0, 1.1, 2.1 and 4.6 years in 1996–1999, 2000–2003, 2004–2007 and 2008–2011, and median second cART durations were 0.9, 1.2, 2.8 and 3.9 years, respectively (both p<0.001). Comparing 1996–1999 and 2008–2011, the percentage of patients who achieved an undetectable HIV RNA within 6 months of first cART initiation increased from 65% to 81%, and from 63% to 80% on second cART (both p<0.001). Among patients initiating first cART during 2008–2011, black non-Hispanic/Latino race/ethnicity and ≥twice daily dosing were significantly associated with higher rates of regimen modification (p<0.05), and higher baseline HIV RNA levels were associated with failure to achieve an undetectable HIV RNA (p<0.001). Conclusions: Among HIV-infected U.S. adults in routine HIV care, durability of first and second cART regimens and the likelihood of prompt virologic suppression increased during 1996–2011, coincident with the availability of more tolerable, less complex cART options.

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