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Choy CY, Wong CS, Kumar PA, Olszyna DP, Teh YE, Chien MFJ, Kurup A, Koh YL, Ho LP, Law HL, Chua NGS, Yong HYJ, Archuleta S. Recommendations for the use of antiretroviral therapy in adults living with human immunodeficiency virus in Singapore. Singapore Med J 2024; 65:259-273. [PMID: 35366662 PMCID: PMC11182460 DOI: 10.11622/smedj.2021174] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 07/06/2021] [Indexed: 11/18/2022]
Abstract
ABSTRACT Since the advent of combination antiretroviral therapy (ART), the mortality attributable to human immunodeficiency virus (HIV) infection has decreased by 80%. Newer antiretroviral agents are highly efficacious, have minimal side effects as compared to older drugs, and can be formulated as combination tablets to reduce patients' pill burden. Despite these advances, 680,000 people worldwide died of acquired immunodeficiency syndrome-related illnesses in 2020. The National ART and Monitoring Recommendations by the National HIV Programme have been created to guide physicians on the prescribing of ART based on the patients' needs. These recommendations are based on international guidelines and tailored to the local context and unique domestic considerations. We hoped that with the publication of these recommendations, the care of people living with HIV can be enhanced, bringing us closer to ending HIV in our lifetime.
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Affiliation(s)
- Chiaw Yee Choy
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
| | - Chen Seong Wong
- Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore
- National Centre for Infectious Diseases, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - P Arun Kumar
- National Centre for Infectious Diseases, Singapore
| | - Dariusz Piotr Olszyna
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore
| | - Yii Ean Teh
- Department of Infectious Diseases, Singapore General Hospital, Singapore
| | | | - Asok Kurup
- Infectious Diseases Care Pte Ltd, Mount Elizabeth Medical Centre, Singapore
| | - Yin Ling Koh
- The Novena Medical Specialists, Mount Elizabeth Novena Specialist Centre, Singapore
| | - Lai Peng Ho
- Department of Care and Counselling, Tan Tock Seng Hospital, Singapore
| | - Hwa Lin Law
- Department of Pharmacy, Tan Tock Seng Hospital, Singapore
| | | | | | - Sophia Archuleta
- National Centre for Infectious Diseases, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
- Division of Infectious Diseases, University Medicine Cluster, National University Hospital, Singapore
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Yin DE, Cole SR, Ludema C, Brookhart MA, Golin CE, Miller WC, McKinney RE. A Per-Protocol Analysis Using Inverse-Probability-of-Censoring Weights in a Randomized Trial of Initial Protease Inhibitor Versus Nonnucleoside Reverse Transcriptase Inhibitor Regimens in Children. Am J Epidemiol 2023; 192:916-928. [PMID: 36896583 PMCID: PMC10505414 DOI: 10.1093/aje/kwad054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2021] [Revised: 12/05/2022] [Accepted: 03/07/2023] [Indexed: 03/11/2023] Open
Abstract
Protocol adherence may influence measured treatment effectiveness in randomized controlled trials. Using data from a multicenter trial (Europe and the Americas, 2002-2009) of children with human immunodeficiency virus type 1 who had been randomized to receive initial protease inhibitor (PI) versus nonnucleoside reverse transcriptase inhibitor (NNRTI) antiretroviral therapy regimens, we generated time-to-event intention-to-treat (ITT) estimates of treatment effectiveness, applied inverse-probability-of-censoring weights to generate per-protocol efficacy estimates, and compared shifts from ITT to per-protocol estimates across and within treatment arms. In ITT analyses, 263 participants experienced 4-year treatment failure probabilities of 41.3% for PIs and 39.5% for NNRTIs (risk difference = 1.8% (95% confidence interval (CI): -10.1, 13.7); hazard ratio = 1.09 (95% CI: 0.74, 1.60)). In per-protocol analyses, failure probabilities were 35.6% for PIs and 29.2% for NNRTIs (risk difference = 6.4% (95% CI: -6.7, 19.4); hazard ratio = 1.30 (95% CI: 0.80, 2.12)). Within-arm shifts in failure probabilities from ITT to per-protocol analyses were 5.7% for PIs and 10.3% for NNRTIs. Protocol nonadherence was nondifferential across arms, suggesting that possibly better NNRTI efficacy may have been masked by differences in within-arm shifts deriving from differential regimen forgiveness, residual confounding, or chance. A per-protocol approach using inverse-probability-of-censoring weights facilitated evaluation of relationships among adherence, efficacy, and forgiveness applicable to pediatric oral antiretroviral regimens.
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Affiliation(s)
- Dwight E Yin
- Correspondence to Dr. Dwight E. Yin, Divisions of Infectious Diseases and Clinical Pharmacology, Medical Toxicology and Therapeutic Innovation, Children’s Mercy Kansas City, 2401 Gillings Road, Kansas City, MO 64108 (e-mail: )
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Mortality and Attrition Rates within the First Year of Antiretroviral Therapy Initiation among People Living with HIV in Guangxi, China: An Observational Cohort Study. BIOMED RESEARCH INTERNATIONAL 2021; 2021:6657112. [PMID: 33628803 PMCID: PMC7892219 DOI: 10.1155/2021/6657112] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/12/2020] [Revised: 01/14/2021] [Accepted: 01/21/2021] [Indexed: 02/06/2023]
Abstract
Objective To assess the mortality and attrition rates within the first year of antiretroviral therapy (ART) initiation among people living with human immunodeficiency virus (PLHIV) in rural Guangxi, China. Design Observational cohort study. Setting. The core treatment indicators and data were collected with standard and essential procedures as per the Free ART Manual guidelines across all the rural health care centers of Guangxi. Participants. 58,115 PLHIV who were under ART were included in the study. Interventions. The data collected included sociodemographic characteristics that consist of age, sex, marital status, route of HIV transmission, CD4 cell count before ART, initial ART regimen, level of ART site, and year of ART initiation. Primary and Secondary Outcome Measures. Mortality and attrition rate following ART initiation. Results The average mortality rate was 5.94 deaths, and 17.52 attritions per 100 person-years within the first year of ART initiation among PLHIV. The mortality rate was higher among intravenous drug users (Adjusted Hazard Ratio (AHR) 1.27, 95% Confidence Interval (CI) 1.14-1.43), prefecture as a level of ART site (AHR 1.14, 95% CI 1.02-1.28), and county as the level of ART site (AHR 2.12, 95% CI 1.90-2.37). Attrition was higher among intravenous drug users (AHR 1.87, 95% CI 1.75-2.00), the first-line ART containing AZT (AHR 1.09, 95% CI 1.03-1.16), and first-line ART containing LVP/r (AHR 1.34, 95% CI 1.23-1.46). Conclusion The mortality and attrition rates were both at the highest level in the first year of post-ART; continued improvement in the quality of HIV treatment and care is needed.
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Protease Inhibitors or NNRTIs as First-Line HIV-1 Treatment in West Africa (PIONA): A Randomized Controlled Trial. J Acquir Immune Defic Syndr 2019; 79:386-393. [PMID: 30044302 DOI: 10.1097/qai.0000000000001820] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Nonnucleoside reverse transcriptase inhibitors (NNRTIs) are recommended as part of first-line treatment for HIV-1 in Africa. However, NNRTI-based regimens are more prone to resistance development than protease inhibitors (PIs) in a context in which drug interruptions are frequent. The aim of this study was to compare the efficacy and tolerability of NNRTIs with PIs in HIV-1-infected patients in Guinea-Bissau. METHODS This open-label randomized, 2-arm superiority trial compared the use of 2 NRTIs plus either one NNRTI (efavirenz or nevirapine) or one PI (lopinavir/ritonavir) in treatment-naive HIV-1-infected adults in the Bissau HIV Cohort (ClinicalTrials.gov, NCT0019235). The primary endpoint was HIV-1 RNA <400 copies per milliliter after 12 months of treatment. RESULTS Between May 5, 2011, and April 26, 2013, 400 patients were included in the study. In an intention-to-treat analysis, the proportions of patients with viral suppression were similar in the NNRTI [65/197 (33.0%)] and PI [68/203 (33.5%)] arms (P = 0.92). No PI resistance was detected, but high-level NNRTI resistance was seen in 17/30 (56.7%) of NNRTI vs. 3/26 (11.5%) of PI-treated patients, P < 0.01. After 1 year of follow-up, 65 patients died (16.3%) and 93 were lost to follow-up (23.3%). There was no difference in mortality (hazard ratio 0.84, 95% confidence interval: 0.51 to 1.36) or frequency of clinical adverse events between treatment arms [NNRTI: 73/197 (37.1%); and PI: 69/203 (34.0%); P = 0.52]. CONCLUSIONS In patients at an HIV clinic in Guinea-Bissau, treatment with PIs led to less development of resistance compared with NNRTIs but was not superior in terms of viral suppression, CD4 cell increment, mortality, or severe adverse events.
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Snedecor SJ, Radford M, Kratochvil D, Grove R, Punekar YS. Comparative efficacy and safety of dolutegravir relative to common core agents in treatment-naïve patients infected with HIV-1: a systematic review and network meta-analysis. BMC Infect Dis 2019; 19:484. [PMID: 31146698 PMCID: PMC6543679 DOI: 10.1186/s12879-019-3975-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2019] [Accepted: 04/11/2019] [Indexed: 01/30/2023] Open
Abstract
Background Network meta-analyses (NMAs) provide comparative treatment effects estimates in the absence of head-to-head randomized controlled trials (RCTs). This NMA compared the efficacy and safety of dolutegravir (DTG) with other recommended or commonly used core antiretroviral agents. Methods A systematic review identified phase 3/4 RCTs in treatment-naïve patients with HIV-1 receiving core agents: ritonavir-boosted protease inhibitors (PIs), non-nucleoside reverse transcriptase inhibitors (NNRTIs), or integrase strand inhibitors (INSTIs). Efficacy (virologic suppression [VS], CD4+ cell count change from baseline) and safety (adverse events [AEs], discontinuations, discontinuation due to AEs, lipid changes) were analyzed at Week 48 using Bayesian NMA methodology, which allowed calculation of probabilistic results. Subgroup analyses were conducted for VS (baseline viral load [VL] ≤/> 100,000copies/mL, ≤/> 500,000copies/mL; baseline CD4+ ≤/>200cells/μL). Results were adjusted for the nucleoside/nucleotide reverse transcriptase inhibitors (NRTI) combined with the core agent (except subgroup analyses). Results The NMA included 36 studies; 2 additional studies were included in subgroup analyses only. Odds of achieving VS with DTG were statistically superior to PIs (odds ratios [ORs] 1.78–2.59) and NNRTIs (ORs 1.51–1.86), and similar but numerically higher than other INSTIs. CD4+ count increase was significantly greater with DTG than PIs (difference: 23.63–31.47 cells/μL) and efavirenz (difference: 34.54 cells/μL), and similar to other core agents. INSTIs were more likely to result in patients achieving VS versus PIs (probability: 76–100%) and NNRTIs (probability: 50–100%), and a greater CD4+ count increase versus PIs (probability: 72–100%) and NNRTIs (probability: 60–100%). DTG was more likely to result in patients achieving VS (probability: 94–100%), and a greater CD4+ count increase (probability: 53–100%) versus other core agents, including INSTIs (probability: 94–97% and 53–93%, respectively). Safety outcomes with DTG were generally similar to other core agents. In patients with baseline VL > 100,000copies/mL or ≤ 200 CD4+cells/μL (18 studies), odds of achieving VS with DTG were superior or similar to other core agents. Conclusion INSTI core agents had superior efficacy and similar safety to PIs and NNRTIs at Week 48 in treatment-naïve patients with HIV-1, with DTG being among the most efficacious, including in patients with baseline VL > 100,000copies/mL or ≤ 200 CD4+cells/μL, who can be difficult to treat. Electronic supplementary material The online version of this article (10.1186/s12879-019-3975-6) contains supplementary material, which is available to authorized users.
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Affiliation(s)
| | - Matthew Radford
- ViiV Healthcare, GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK
| | | | | | - Yogesh S Punekar
- ViiV Healthcare, GSK House, 980 Great West Rd, Brentford, Middlesex, TW8 9GS, UK.
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Ayele TA, Worku A, Kebede Y, Alemu K, Kasim A, Shkedy Z. Choice of initial antiretroviral drugs and treatment outcomes among HIV-infected patients in sub-Saharan Africa: systematic review and meta-analysis of observational studies. Syst Rev 2017; 6:173. [PMID: 28841912 PMCID: PMC5574138 DOI: 10.1186/s13643-017-0567-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2016] [Accepted: 08/15/2017] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The effectiveness of antiretroviral therapy (ART) depends on the choice of regimens during initiation. Most evidences from developed countries indicated that there is difference between efavirenz (EFV) and nevirapine (NVP). However, the evidences are limited in resource poor countries particularly in Africa. Thus, this systematic review and meta-analysis was carried out to summarize reported long-term treatment outcomes among people on first line therapy in sub-Saharan Africa. METHODS Observational studies that reported odds ratio, relative risk, hazard ratio, or standardized incidence ratio to compare risk of treatment failure among HIV/AIDS patients who initiated ART with EFV versus NVP were systematically searched. Searches were conducted using the MEDLINE database within PubMed, Google Scholar, HINARI, and Research Gates between 2007 and 2016. Information was extracted using standardized form. Pooled risk ratios (RR) and 95% confidence intervals (CI) were calculated using random-effect, generic inverse variance method. RESULT A total of 6394 articles were identified, of which, 29 were eligible for review and abstraction in sub-Saharan Africa. Seventeen articles were used for the meta-analysis. Of a total of 121,092 independent study participants, 76,719 (63.36%) were females. Of these, 40,480 (33.43%) initiated with NVP containing regimen. Two studies did not report the median CD4 cell counts at initiation. Patients who have low CD4 cell counts initiated with EFV containing regimen. The pooled effect size indicated that treatment failure was reduced by 15%, 0.85 (95%CI: 0.75-0.98), and non-nucleoside reverse transcriptase inhibitor (NNRTI) switch was reduced by 43%, 0.57 (95%CI: 0.37-0.89). CONCLUSION The risk of treatment failure and NNRTI switch were lower in patients who initiated with EFV than NVP-containing regimen. The review suggests that initiation of patients with EFV-containing regimen will reduce treatment failure and NNRTI switch.
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Affiliation(s)
- Tadesse Awoke Ayele
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Alemayehu Worku
- School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia
| | - Yigzaw Kebede
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia
| | - Kassahun Alemu
- Department of Epidemiology and Biostatistics, Institute of Public Health, University of Gondar, Gondar, Ethiopia.
| | - Adetayo Kasim
- Wolfson Research Institute, Durham University, Durham, UK
| | - Ziv Shkedy
- I-BioStat, Hasselt University, Diepenbeek, Belgium
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Byabene AK, Fortes-Déguénonvo L, Niang K, Manga MN, Bulabula ANH, Nachega JB, Seydi M. Optimal antiretroviral therapy adherence as evaluated by CASE index score tool is associated with virological suppression in HIV-infected adults in Dakar, Senegal. Trop Med Int Health 2017; 22:776-782. [PMID: 28407436 DOI: 10.1111/tmi.12882] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To determine the prevalence and factors associated with optimal antiretroviral therapy (ART) adherence and virological failure (VLF) among HIV-infected adults enrolled in the national ART programme at the teaching hospital of Fann, Dakar, Senegal. METHODS Cross-sectional study from 1 September 2013 to 30 January 2014. OUTCOMES (1) optimal ART adherence by the Center for Adherence Support Evaluation (CASE) Index Score (>10) and (2) VLF (HIV RNA > 1000 copies/ml). Diagnostic accuracy of CASE Index Score assessed using sensitivity (Se), specificity (Sp), positive predictive value (PPV), negative predictive value (NPV) and corresponding 95% confidence intervals (CIs). Multivariate logistic regression analysis was performed to identify independent factors associated with optimal adherence and VLF. RESULTS Of 98 HIV-infected patients on ART, 68% were female. The median (IQR) age was 42 (20-50) years. A total of 57 of 98 (60%) were on ART more than 3 years, and majority (88%) were on NNRTI-based first-line ART regimen. A total of 79 of 98 (80%) patients reported optimal ART adherence, and only five of 84 (5.9%) had documented VLF. Patients with VLF were significantly more likely to have suboptimal ART adherence (17.7% vs. 2.9%; P = 0.02). CASE Index Score showed the best trade-off in Se (78.9%, 95% CI: 54.4-93.9%), Sp (20.0%, 95% CI: 11.1-31.7), PPV (22.4, 95% CI: 13.1-34.2%) and NPV (76.5%, 95% CI: 50.1-93.2), when used VLF threshold of HIV RNA >50 copies/ml. Factors independently associated with VLF were CASE Index Score <10 ([aOR] = 13.0, 95% CI: 1.1-147.9; P = 0.04) and being a boosted PI-based ART regimen ([aOR] = 27.0, 95% CI: 2.4-309.4; P = 0.008). CONCLUSIONS Optimal ART adherence is achievable in a high proportion of HIV-infected adults in this study population. CASE Index Score was independently associated with virological outcomes, supporting usefulness of this low-cost ART adherence monitoring tool in this setting.
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Affiliation(s)
- A K Byabene
- Departement de Medecine Interne, Université Evangelique en Afrique, Bukavu, Republiqe Democratique du Congo.,Clinique des Maladies Infectieuses, CHU de Fann, Universite Cheikh Anta Diop, Dakar, Senegal.,The International Center for Advanced Research and Training (ICART), Bukavu, Democratic Republic of the Congo
| | - L Fortes-Déguénonvo
- Clinique des Maladies Infectieuses, CHU de Fann, Universite Cheikh Anta Diop, Dakar, Senegal
| | - K Niang
- Institut de Sante et Developpement, Universite Cheikh Anta Diop, Dakar, Senegal
| | - M N Manga
- Clinique des Maladies Infectieuses, CHU de Fann, Universite Cheikh Anta Diop, Dakar, Senegal
| | - A N H Bulabula
- The International Center for Advanced Research and Training (ICART), Bukavu, Democratic Republic of the Congo.,Department of Interdisciplinary Health Sciences, Unit for Infection Prevention and Control, Stellenbosch University, Cape Town, South Africa
| | - J B Nachega
- Departement de Medecine Interne, Université Evangelique en Afrique, Bukavu, Republiqe Democratique du Congo.,The International Center for Advanced Research and Training (ICART), Bukavu, Democratic Republic of the Congo.,Department of Medicine and Centre for Infectious Diseases, Stellenbosch University, Cape Town, South Africa.,Departments of Epidemiology, Infectious Diseases and Microbiology, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA, USA.,Department of Epidemiology and International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - M Seydi
- Clinique des Maladies Infectieuses, CHU de Fann, Universite Cheikh Anta Diop, Dakar, Senegal
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Taieb F, Madec Y, Cournil A, Delaporte E. Virological success after 12 and 24 months of antiretroviral therapy in sub-Saharan Africa: Comparing results of trials, cohorts and cross-sectional studies using a systematic review and meta-analysis. PLoS One 2017; 12:e0174767. [PMID: 28426819 PMCID: PMC5398519 DOI: 10.1371/journal.pone.0174767] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 03/15/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND UNAIDS recently defined the 90-90-90 target as a way to end the HIV epidemic. However, the proportion of virological success following antiretroviral therapy (ART) may not be as high as the anticipated 90%, and may in fact be highly heterogeneous. We aimed to describe the proportion of virological success in sub-Saharan Africa and to identify factors associated with the proportion of virological success. METHODS We performed a systematic review and meta-analysis focusing on the proportion of patients in sub-Saharan Africa who demonstrate virological success at 12 and 24 months since ART initiation, as well as at 6 and 36 months, where possible. Programme factors associated with the proportion of virological success were identified using meta-regression. Analyses were conducted using both on-treatment (OT) and intention-to-treat (ITT) approaches. RESULTS Eighty-five articles were included in the meta-analysis, corresponding to 125 independent study populations. Using an on-treatment approach, the proportions (95% confidence interval (CI)) of virological success at 12 (n = 64) and at 24 (n = 32) months since ART initiation were 87.7% (81.3-91.0) and 83.7% (79.8-87.6), respectively. Univariate analysis indicated that the proportion of virological success was not different by study design. Multivariate analysis at 24 months showed that the proportion of virological success was significantly larger in studies conducted in public sector sites than in other sites (p = 0.045). Using an ITT approach, the proportions (95% CI) of virological success at 12 (n = 50) and at 24 (n = 20) months were 65.4% (61.8-69.1) and 56.8% (51.3-62.4), respectively. At 12 months, multivariate analysis showed that the proportion of success was significantly lower in cohort studies than in trials (63.0% vs. 71.1%; p = 0.017). At 24 months, univariate analysis demonstrated that the proportion of success was also lower in cohorts. DISCUSSION Regardless of the time following ART initiation, and of the threshold, proportions of virological success were highly variable. Evidence from this review suggests that the new international target of 90% of patients controlled is not yet being achieved, and that in order to improve the virological outcome, efforts should be made to improve retention in care.
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Affiliation(s)
- Fabien Taieb
- Emerging Diseases Epidemiology Unit-Institut Pasteur, Paris, France
- IRD UMI 233 INSERM U1175 Université de Montpellier, Unité TransVIHMI, Montpellier, France
- Direction de la Recherche Clinique et du Développement-Assistance Publique des Hôpitaux de Paris-Hôpital Saint-Louis, Paris, France
- * E-mail:
| | - Yoann Madec
- Emerging Diseases Epidemiology Unit-Institut Pasteur, Paris, France
| | - Amandine Cournil
- IRD UMI 233 INSERM U1175 Université de Montpellier, Unité TransVIHMI, Montpellier, France
| | - Eric Delaporte
- IRD UMI 233 INSERM U1175 Université de Montpellier, Unité TransVIHMI, Montpellier, France
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Dalal B, Shankarkumar A, Ghosh K. Individualization of antiretroviral therapy--pharmacogenomic aspect. Indian J Med Res 2016; 142:663-74. [PMID: 26831415 PMCID: PMC4774063 DOI: 10.4103/0971-5916.174549] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
Combination therapy with three drug regimens for human immunodeficiency virus (HIV) infection significantly suppresses the viral replication. However, this therapeutic impact is restricted by adverse drug events and response in terms of short and long term efficacy. There are multiple factors involved in different responses to antiretrovirals (ARVs) such as age, body weight, disease status, diet and heredity. Pharmacogenomics deals with individual genetic make-up and its role in drug efficacy and toxicity. In depth genetic research has provided evidence to predict the risk of developing certain toxicities for which personalized screening and surveillance protocols may be developed to prevent side effects. Here we describe the use of pharmacogenomics for optimal use of HAART (highly active antiretroviral therapy).
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Affiliation(s)
| | - Aruna Shankarkumar
- Department of Transfusion Transmitted Disease, National Institute of Immunohaematology (ICMR), Mumbai, India
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Barlow-Mosha L, Angelidou K, Lindsey J, Archary M, Cotton M, Dittmer S, Fairlie L, Kabugho E, Kamthunzi P, Kinikar A, Mbengeranwa T, Msuya L, Sambo P, Patel K, Barr E, Jean-Phillipe P, Violari A, Mofenson L, Palumbo P, Chi BH. Nevirapine- Versus Lopinavir/Ritonavir-Based Antiretroviral Therapy in HIV-Infected Infants and Young Children: Long-term Follow-up of the IMPAACT P1060 Randomized Trial. Clin Infect Dis 2016; 63:1113-1121. [PMID: 27439527 DOI: 10.1093/cid/ciw488] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2016] [Accepted: 07/03/2016] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND The International Maternal Pediatric Adolescent AIDS Clinical Trials Network (IMPAACT) P1060 study demonstrated short-term superiority of lopinavir/ritonavir (LPV/r) over nevirapine (NVP) in antiretroviral therapy (ART), regardless of prior NVP exposure. However, NVP-based ART had a marginal benefit in CD4 percentage (CD4%) and growth. We compared 5-year outcomes from this clinical trial. METHODS Human immunodeficiency virus (HIV)-infected, ART-eligible children were enrolled into 2 cohorts based on prior NVP exposure and randomized to NVP- or LPV/r-based ART. The data safety monitoring board recommended unblinding results in both cohorts due to superiority of LPV/r for the primary endpoint: stopping randomized treatment, virologic failure (VF), or death by 6 months. Participants were offered a switch in regimens (if on NVP) and continued observational follow-up. We compared time to VF or death, death, and CD4% and growth changes using intention-to-treat analyses. Additionally, inverse probability weights were used to account for treatment switching and censoring. RESULTS As of September 2014, 329 of the 451 (73%) enrolled participants were still in follow-up (median, 5.3 years; interquartile range [IQR], 4.3-6.4), with 52% on NVP and 88% on LPV/r as originally randomized. NVP arm participants had significantly higher risk of VF or death (adjusted hazard ratio [aHR], 1.90; 95% confidence interval [CI], 1.37-2.65) but not death alone (aHR, 1.65; 95% CI, .72-3.76) compared with participants randomized to LPV/r. Mean CD4% was significantly higher in the NVP arm up to 1 year after ART initiation, but not beyond. Mean weight-for-age z scores were marginally higher in the NVP arm, but height-for-age z scores did not differ. Similar trends were observed in sensitivity analyses. CONCLUSIONS These findings support the current World Health Organization recommendation of LPV/r in first-line ART regimens for HIV-infected children. CLINICAL TRIALS REGISTRATION NCT00307151.
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Affiliation(s)
- Linda Barlow-Mosha
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | - Jane Lindsey
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | | | | | - Lee Fairlie
- Wits Reproductive Health and HIV Institute, Johannesburg, South Africa
| | - Enid Kabugho
- Makerere University-Johns Hopkins University Research Collaboration, Kampala, Uganda
| | | | | | - Tapiwa Mbengeranwa
- University of Zimbabwe-University of California, San Francisco Collaborative Research Programme, Harare, Zimbabwe
| | - Levina Msuya
- Kilimanjaro Christian Medical College, Moshi, Tanzania
| | | | - Kunjal Patel
- Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | | | - Patrick Jean-Phillipe
- HJF-DAIDS, Henry M. Jackson Foundation for the Advancement of Military Medicine, Bethesda, Maryland
| | | | - Lynne Mofenson
- Elizabeth Glaser Pediatric AIDS Foundation, Washington, District of Columbia
| | - Paul Palumbo
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire
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Borges ÁH, Lundh A, Tendal B, Bartlett JA, Clumeck N, Costagliola D, Daar ES, Echeverría P, Gisslén M, Huedo-Medina TB, Hughes MD, Huppler Hullsiek K, Khabo P, Komati S, Kumar P, Lockman S, MacArthur RD, Maggiolo F, Matteelli A, Miro JM, Oka S, Petoumenos K, Puls RL, Riddler SA, Sax PE, Sierra-Madero J, Torti C, Lundgren JD. Nonnucleoside Reverse-transcriptase Inhibitor- vs Ritonavir-boosted Protease Inhibitor-based Regimens for Initial Treatment of HIV Infection: A Systematic Review and Metaanalysis of Randomized Trials. Clin Infect Dis 2016; 63:268-80. [PMID: 27090986 PMCID: PMC6276924 DOI: 10.1093/cid/ciw236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2015] [Accepted: 04/07/2016] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Previous studies suggest that nonnucleoside reverse-transcriptase inhibitors (NNRTIs) cause faster virologic suppression, while ritonavir-boosted protease inhibitors (PI/r) recover more CD4 cells. However, individual trials have not been powered to compare clinical outcomes. METHODS We searched databases to identify randomized trials that compared NNRTI- vs PI/r-based initial therapy. A metaanalysis calculated risk ratios (RRs) or mean differences (MDs), as appropriate. Primary outcome was death or progression to AIDS. Secondary outcomes were death, progression to AIDS, and treatment discontinuation. We calculated RR of virologic suppression and MD for an increase in CD4 cells at week 48. RESULTS We included 29 trials with 9047 participants. Death or progression to AIDS occurred in 226 participants in the NNRTI arm and in 221 in the PI/r arm (RR, 1.03; 95% confidence interval, .87-1.22; 12 trials; n = 3825), death in 205 participants in the NNRTI arm vs 198 in the PI/r arm (1.04; 0.86-1.25; 22 trials; n = 8311), and progression to AIDS in 140 participants in the NNRTI arm vs 144 in the PI/r arm (1.00; 0.80-1.25; 13 trials; n = 4740). Overall treatment discontinuation (1.12; 0.93-1.35; 24 trials; n = 8249) and from toxicity (1.21; 0.87-1.68; 21 trials; n = 6195) were comparable, but discontinuation due to virologic failure was more common with NNRTI (1.58; 0.91-2.74; 17 trials; n = 5371). At week 48, there was no difference between NNRTI and PI/r in virologic suppression (RR, 1.03; 0.98-1.09) or CD4(+) recovery (MD, -4.7 cells; -14.2 to 4.8). CONCLUSIONS We found no difference in clinical and viro-immunologic outcomes between NNRTI- and PI/r-based therapy.
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Affiliation(s)
- Álvaro H. Borges
- Centre for Health & Infectious Diseases Research, Department of Infectious
Diseases,Rigshospitalet, University of Copenhagen
| | - Andreas Lundh
- Department of Internal Medicine, Zealand University
Hospital, Roskilde
- The Nordic Cochrane Centre,
Rigshospitalet
| | | | - John A. Bartlett
- Kilimanjaro Christian Medical Centre,
Moshi, Tanzania
- Duke Global Health Institute, Duke
University, Durham, North Carolina
| | - Nathan Clumeck
- Department of Infectious Diseases, St Pierre University
Hospital, Brussels, Belgium
| | - Dominique Costagliola
- Institut Pierre Louis d'Epidémiologie et de Santé Publique,
INSERM et Sorbonne Universités, Paris,
France
| | - Eric S. Daar
- Department of Medicine, Los Angeles Biomedical Research
Institute at Harbor-UCLA Medical Center, Torrance,
California
| | - Patrícia Echeverría
- Department of HIV, Lluita contra la Sida Foundation,
Germans Trias i Pujol University Hospital, Autonomous University of
Barcelona, Spain
| | - Magnus Gisslén
- Department of Infectious Diseases, Sahlgrenska Academy
at the University of Gothenburg, Sweden
| | | | - Michael D. Hughes
- Department of Biostatistics, Harvard School of Public
Health, Boston, Massachusetts
| | | | | | | | | | - Shahin Lockman
- Department of Immunology and Infectious Diseases,
Harvard School of Public Health
- Division of Infectious Diseases, Brigham and Women's
Hospital, Harvard Medical School, Boston,
Massachusetts
| | | | | | - Alberto Matteelli
- Institute of Infectious and Tropical Diseases,
University of Brescia, Italy
| | - Jose M. Miro
- Infectious Diseases Service, Hospital Clinic-IDIBAPS,
University of Barcelona, Spain
| | - Shinichi Oka
- AIDS Clinical Center, National Center for Global Health
and Medicine, Tokyo, Japan
| | | | | | | | - Paul E. Sax
- Division of Infectious Diseases, Brigham and Women's
Hospital, Harvard Medical School, Boston,
Massachusetts
| | | | - Carlo Torti
- University Unit of Infectious Diseases, Department of Medical and Surgical
Sciences, University Magna Graecia,
Catanzaro, Italy
| | - Jens D. Lundgren
- Centre for Health & Infectious Diseases Research, Department of Infectious
Diseases,Rigshospitalet, University of Copenhagen
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12
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Xing L, Wang S, Hu Q, Li J, Zeng Y. Comparison of three quantification methods for the TZM-bl pseudovirus assay for screening of anti-HIV-1 agents. J Virol Methods 2016; 233:56-61. [PMID: 27016178 DOI: 10.1016/j.jviromet.2016.03.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2015] [Revised: 03/10/2016] [Accepted: 03/22/2016] [Indexed: 11/17/2022]
Abstract
The TZM-bl pseudovirus assay is commonly used to evaluate the efficacy of neutralizing antibodies and small molecular inhibitors in HIV-1 research. Here, to determine the optimal measurement method for screening anti-HIV-1 inhibitors, we compared three measurement methods based on firefly luciferase and β-galactosidase activities. The 50% tissue culture infective doses (TCID50) of the pseudoviruses were determined using the luciferase, β-galactosidase colorimetric, and 5-bromo-4-chloro-3-indolyl-β-D-galactopyranoside (X-gal) staining assays. Three commercial reverse-transcriptase inhibitors (azidothymidine, nevirapine, and lamivudine) were tested as reference drugs to compare the reproducibility, linear correlation, and half maximal inhibitory concentration (IC50) values determined using these methods. In the TCID50 assay, the sensitivity of β-galactosidase colorimetric assay was almost 562 times lower than that of the other two methods. Reproducible dose-response curves were obtained for the inhibitors with all methods; the IC50 values of the inhibitors were not significantly different. Linear regression analysis showed linear correlation between methods. Compared to the β-galactosidase colorimetric assay, the other two methods have the advantage of high sensitivity and are less affected by interference. In conclusion, the luciferase and X-gal staining assays, which can be applied either alone or combined, are recommended for anti-HIV-1 inhibitor screening.
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Affiliation(s)
- Liying Xing
- College of Life Science and Bioengineering, Beijing University of Technology, No. 100 Pingleyuan, Beijing 100124, PR China
| | - Shunyi Wang
- College of Life Science and Bioengineering, Beijing University of Technology, No. 100 Pingleyuan, Beijing 100124, PR China
| | - Qin Hu
- College of Life Science and Bioengineering, Beijing University of Technology, No. 100 Pingleyuan, Beijing 100124, PR China.
| | - Jingtao Li
- College of Life Science and Bioengineering, Beijing University of Technology, No. 100 Pingleyuan, Beijing 100124, PR China
| | - Yi Zeng
- College of Life Science and Bioengineering, Beijing University of Technology, No. 100 Pingleyuan, Beijing 100124, PR China
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13
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Scarsi KK, Eisen G, Darin KM, Meloni ST, Rawizza HE, Tchetgen Tchetgen EJ, Agbaji OO, Onwujekwe DI, Gashau W, Nkado R, Okonkwo P, Murphy RL, Kanki PJ. Superior Effectiveness of Zidovudine Compared With Tenofovir When Combined With Nevirapine-based Antiretroviral Therapy in a Large Nigerian Cohort. Clin Infect Dis 2015; 62:512-8. [PMID: 26561532 PMCID: PMC4725384 DOI: 10.1093/cid/civ928] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Accepted: 09/04/2015] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Despite sparse efficacy data, tenofovir-emtricitabine or tenofovir-lamivudine plus nevirapine is used in many resource-constrained settings. METHODS This retrospective cohort study included patients initiating nevirapine-based antiretroviral therapy (ART) with either tenofovir-emtricitabine or lamivudine (tenofovir group) or zidovudine-lamivudine (zidovudine group). Clinical, virologic, and immunologic evaluations were performed at baseline and every 6 months. Virologic failure was defined as 2 consecutive human immunodeficiency virus (HIV)-RNA values >1000 copies/mL. Patients were included from ART initiation until time of failure, regimen switch, discontinuation, or last HIV-RNA measurement. Cox proportional hazards regression was used to model factors influencing time to failure. Bias due to dependent censoring was investigated via inverse probability weighted pooled logistic regression. RESULTS A total of 5547 patients were evaluated; 1484 (26.8%) were in the tenofovir group and 4063 (73.2%) were in the zidovudine group. In the adjusted model, tenofovir regimen (hazard ratio [HR], 1.47; 95% confidence interval [CI], 1.21-1.79) and higher baseline log10 HIV-RNA (HR, 1.15; 95% CI, 1.03-1.28) were associated with virologic failure. Higher baseline log10 CD4+ cell count (HR, 0.50; 95% CI, .40-.63) and increasing age (HR, 0.98; 95% CI, .97-.99) decreased the risk of virologic failure. Inverse probability weighting results were consistent with the primary analysis. CONCLUSIONS Compared with zidovudine-lamivudine, the use of tenofovir-lamivudine or emtricitabine in combination with nevirapine was a strong predictor of virologic failure in our cohort, which was not explained by other risk factors or criteria for regimen selection.
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Affiliation(s)
- Kimberly K Scarsi
- Department of Pharmacy Practice, University of Nebraska Medical Center, Omaha
| | - Geoffrey Eisen
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Kristin M Darin
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Seema T Meloni
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health
| | - Holly E Rawizza
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health Department of Medicine, Division of Infectious Diseases, Brigham and Women's Hospital
| | - Eric J Tchetgen Tchetgen
- Departments of Biostatistics and Epidemiology, Harvard T. H. Chan School of Public Health, Boston, Massachusetts
| | - Oche O Agbaji
- Department of Medicine, University of Jos and Jos University Teaching Hospital
| | - Daniel I Onwujekwe
- Clinical Sciences Division, Nigerian Institute of Medical Research, Yaba
| | - Wadzani Gashau
- Department of Medicine, University of Maiduguri Teaching Hospital
| | - Reuben Nkado
- Department of Medicine, 68 Military Hospital, Yaba (formerly, at the time of this work)
| | - Prosper Okonkwo
- AIDS Prevention Initiative Nigeria, Ltd./Gte., Abuja, Nigeria
| | - Robert L Murphy
- Center for Global Health, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Phyllis J Kanki
- Department of Immunology and Infectious Diseases, Harvard T. H. Chan School of Public Health
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14
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van Wyk J, Fredrick LM, Dorr P, Madihlaba T. Efficacy and safety of lopinavir/ritonavir-based antiretroviral therapy in HIV-1-infected subjects with advanced disease: a systematic review and meta-analysis. Future Virol 2015. [DOI: 10.2217/fvl.15.66] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
ABSTRACT Aim: We examined the literature for the efficacy, safety and tolerability of lopinavir/ritonavir (LPV/r)-based regimens in antiretroviral therapy naive HIV-1-infected subjects with advanced disease. Materials & methods: Virologic and immunologic efficacy and adverse event results from prospective, randomized controlled trials evaluating LPV/r + two nucleoside reverse transcriptase inhibitors were examined using random-effects meta-analyses. Emergence of resistance was determined using data extracted from published material. Results: Thirteen studies (including ten 96-week studies) met search criteria. Virologic responses were similar at 96 weeks between subjects with HIV-1 infection treated with LPV/r-based antiretroviral therapy when stratified by baseline HIV-1 RNA or CD4+ T-cell count; immunologic responses were similar when stratified by CD4+ T-cell count. Conclusion: Through 96 weeks of treatment, the efficacy, safety and tolerability of LPV/r-based regimens were comparable in subjects with and without advanced HIV-1 disease.
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Affiliation(s)
- Jean van Wyk
- AbbVie Inc. AP30–3, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Linda M Fredrick
- AbbVie Inc. AP30–3, 1 North Waukegan Road, North Chicago, IL 60064, USA
| | - Pat Dorr
- AbbVie Inc. AP30–3, 1 North Waukegan Road, North Chicago, IL 60064, USA
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15
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Laurent C. Which strategy for ART in resource-limited settings? Lancet HIV 2014; 1:e56-7. [PMID: 26423987 DOI: 10.1016/s2352-3018(14)70026-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Affiliation(s)
- Christian Laurent
- Institut de Recherche pour le Développement (IRD), University Montpellier 1, UMI 233, Montpellier, France.
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