| Title: |
Heavy antiretroviral exposure and exhausted/limited antiretroviral options: Predictors and clinical outcomes |
| Authors: |
Mocroft A.; Pelchen-Matthews A.; Hoy J.; Llibre J. M.; Neesgaard B.; Jaschinski N.; Domingo P.; Rasmussen L. D.; Gunthard H. F.; Surial B.; Ollinger A.; Knappik M.; De Wit S.; Wit F.; Mussini C.; Vehreschild J.; Monforte A. D.; Sonnerborg A.; Castagna A.; Anne A. V.; Vannappagari V.; Cohen C.; Greaves W.; Wasmuth J. C.; Spagnuolo V.; Ryom L. |
| Contributors: |
Mocroft, A.; Pelchen-Matthews, A.; Hoy, J.; Llibre, J. M.; Neesgaard, B.; Jaschinski, N.; Domingo, P.; Rasmussen, L. D.; Gunthard, H. F.; Surial, B.; Ollinger, A.; Knappik, M.; De Wit, S.; Wit, F.; Mussini, C.; Vehreschild, J.; Monforte, A. D.; Sonnerborg, A.; Castagna, A.; Anne, A. V.; Vannappagari, V.; Cohen, C.; Greaves, W.; Wasmuth, J. C.; Spagnuolo, V.; Ryom, L. |
| Publisher Information: |
Lippincott Williams and Wilkins |
| Publication Year: |
2024 |
| Subject Terms: |
clinical events; heavily treatment experienced; limited treatment options |
| Description: |
Objectives:People with HIV and extensive antiretroviral exposure may have limited/exhausted treatment options (LExTO) due to resistance, comorbidities, or antiretroviral-related toxicity. Predictors of LExTO were investigated in the RESPOND cohort.Methods:Participants on ART for at least 5 years were defined as having LExTO when switched to at least two anchor agents and one third antiretroviral (any class), a two-drug regimen of two anchor agents (excluding rilpivirine with dolutegravir/cabotegravir), or at least three nucleoside reverse transcriptase inhibitors. Baseline was the latest of January 1, 2012, cohort enrolment or 5 years after starting antiretrovirals. Poisson regression modeled LExTO rates and clinical events (all-cause mortality, non-AIDS malignancy, cardiovascular disease [CVD], and chronic kidney disease [CKD]).Results:Of 23 827 participants, 2164 progressed to LExTO (9.1%) during 130 061 person-years follow-up (PYFU); incidence 1.66/100 PYFU (95% CI 1.59-1.73). Predictors of LExTO were HIV duration more than 15 years (vs. 7.5-15; adjusted incidence rate ratio [aIRR] 1.32; 95% CI 1.19-1.46), development of CKD (1.84; 1.59-2.13), CVD (1.64; 1.38-1.94), AIDS (1.18; 1.07-1.30), and current CD4+cell count of 350 cells/μl or less (vs. 351-500 cells/μl, 1.51; 1.32-1.74). Those followed between 2018 and 2021 had lower rates of LExTO (vs. 2015-2017; 0.52; 0.47-0.59), as did those with baseline viral load of 200 cp/ml or less (0.46; 0.40-0.53) and individuals under 40. Development of LExTO was not significantly associated with clinical events after adjustment for age and current CD4, except CKD (1.74; 1.48-2.05).Conclusion:Despite an aging and increasingly comorbid population, we found declining LExTO rates by 2018-2021, reflecting recent developments in contemporary ART options and clinical management. Reassuringly, LExTO was not associated with a significantly increased incidence of serious clinical events apart from CKD. |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| Relation: |
info:eu-repo/semantics/altIdentifier/pmid/38079588; info:eu-repo/semantics/altIdentifier/wos/WOS:001177597000021; volume:38; issue:4; firstpage:497; lastpage:508; numberofpages:12; journal:AIDS; https://hdl.handle.net/20.500.11768/172322; https://journals.lww.com/aidsonline/fulltext/2024/03150/heavy_antiretroviral_exposure_and.8.aspx |
| DOI: |
10.1097/QAD.0000000000003798 |
| Availability: |
https://hdl.handle.net/20.500.11768/172322; https://doi.org/10.1097/QAD.0000000000003798; https://journals.lww.com/aidsonline/fulltext/2024/03150/heavy_antiretroviral_exposure_and.8.aspx |
| Rights: |
info:eu-repo/semantics/closedAccess ; license:Tutti i diritti riservati ; license uri:publisher |
| Accession Number: |
edsbas.FDFDB55D |
| Database: |
BASE |