Virologic failure in HIV-infected patients undergoing antiretroviral therapy

January 01, 0001

Virologic failure in HIV-infected patients undergoing antiretroviral therapy

These European authors from multiple countries 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. They also focused on TCVF in patients who started a PI/r-containing regimen after a first-line NNRTI-containing regimen failed.

They found: "45,937 patients followed up for a median of 3.0 years, 980 developed TCVF (2.1%). By 5 and 9 years after starting ART, an estimated 3.4% and 8.6% 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. By 5 years after starting a PI/r regimen as second-line therapy, 46% of patients had developed TCVF."

The authors concluded: "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."

We can’t declare victory over HIV/AIDS yet.

For the full abstract, click here.

Arch Intern Med 170(5):410-419, 8 March 2010 © 2010 to the American Medical Association
Triple-Class Virologic Failure in HIV-Infected Patients Undergoing Antiretroviral Therapy for Up to 10 Years. The Pursuing Later Treatment Options II (PLATO II) Project Team for the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). Correspondence to Dr. Rebecca Lodwick: [email protected]

Category: B. Blood/Blood Forming Organs/Immune Mechanisms, Keywords: human immunodeficiency virus, HIV, virologic failure, antriretroviral therapy, nonnucleoside reverse-transcriptase inhibitor, NNRTI, ritonavir-boosted protease inhibitor, cohort study, journal watch.
Synopsis edited by Dr Linda French, Toledo, Ohio. Posted on Global Family Doctor 23 March 2010

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