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Chen M, Liu C, Xie J, Tang X, Zhang Y, Pan D, Zhong H, Du P, Li Q, Li L, Gu J, Cai W. Effectiveness of integrase strand transfer inhibitors among treatment-naive people living with HIV/AIDS in Guangdong, China: A real-world, retrospective cohort study. Medicine (Baltimore) 2024; 103:e38497. [PMID: 38847660 PMCID: PMC11155602 DOI: 10.1097/md.0000000000038497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Accepted: 05/16/2024] [Indexed: 06/10/2024] Open
Abstract
Integrase strand transfer inhibitors (INSTIs) in anti-retroviral therapy (ART) have been recommended by the World Health Organization for their higher efficacy, favorable safety and tolerability. However, the clinical evidence supporting switching to INSTI-containing regimens in low-and-middle-income countries (LMICs) is limited, as few patients have access to these regimens. We aimed to assess the effectiveness of INSTI-containing regimens in real-world settings in China compared to government-provided free ART. We compared the short-term (first 4 mo following ART initiation) and long-term (1 year after ART initiation) effectiveness between INSTI-containing regimens and free ART drugs provided by the Chinese government in 4 dimensions: viral suppression status, immune response, liver and kidney function, and AIDS-related diseases. We obtained data from electronic medical records in the National Infectious Disease Surveillance System. To control baseline confounders, we used propensity score matching (PSM), calculated using logistic regression including socio-demographic and baseline factors. Among 12,836 patients from 2012 to 2019, 673 (5.2%) used INSTI-containing regimens. Patients with INSTI-containing regimens were matched to those with free drugs (644 vs 644). For short-term effectiveness, patients initiating INSTI-containing regimens were more likely to achieve viral suppression (81.4% vs 52.0%; P < .001). The differences in immune response, liver and kidney function and AIDS-related diseases were not significant between the 2 groups. For long-term effectiveness, viral suppression rates were similar (87.96% vs 84.59%; P = .135), with no significant differences in immune response, liver and kidney function, or AIDS-related diseases. Our study suggests that patients initiating ART with INSTI-containing regimens have worse physical status at baseline than patients starting with free ART drugs. Furthermore, we found better virological performances of INSTI-containing regimens in the short-term but not in the long-term due to a high rate of drug changes. Our findings have clinical implications and provide new evidence regarding the effectiveness of INSTI-containing regimens in LMICs.
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Affiliation(s)
- Mingyu Chen
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Cong Liu
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jinzhao Xie
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Xiaoping Tang
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yao Zhang
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Deng Pan
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Haidan Zhong
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Peishan Du
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Quanmin Li
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Linghua Li
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
| | - Jing Gu
- Department of Medical Statistics, School of Public Health, Sun Yat-Sen University, Guangzhou, China
| | - Weiping Cai
- Infectious Disease Center, Guangzhou Eighth People’s Hospital, Guangzhou Medical University, Guangzhou, China
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Schuettfort G, Cabello A, Cotter AG, Leuw PD, Górgolas M, Hamzah L, Herrmann E, Kann G, Khaykin P, Mena A, Stephan C, Haberl AE. Reasons for Choice of Antiretroviral Regimens in HIV Patients Presenting Late for Initial Treatment in Europe. AIDS Patient Care STDS 2021; 35:110-115. [PMID: 33835853 DOI: 10.1089/apc.2021.0011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
The choice of an optimal antiretroviral therapy (ART) in naive patients presenting late for initial therapy with advanced HIV infection, that is, with a CD4 cell count <200/μL and/or an AIDS-defining disease (late presenters, LPs), is still a challenge, even for HIV specialists. At present, there is little information on the decision process and selection criteria that physicians must take into account when choosing the presumably optimal initial ART for LPs. This study analyzes reasons for the individual choice of first-line ART in HIV LPs. We conducted a prospective multi-center study to analyze the decision-making process of physicians treating naive HIV patients presenting with a CD4 cell count <200/μL and/or an AIDS-defining condition. Two European HIV treatment centers based in Frankfurt (Germany) and A Coruna (Spain) participated in the study. Physicians documented the reasons that led to their decision for a specific first-line ART regimen. A questionnaire was designed for the study. Decisions of the participating physicians were evaluated. A total of 52 treatment decisions were analyzed. Evaluation of the choice of antiretroviral treatment demonstrated that for the overall group of physicians, simplicity of the regimen was the most important selection criterion in 34.6% of cases. The presence of comorbidities was given as the decisive selection criterion in 26.9%, followed by experience with the chosen drugs in 21.2% of cases. In the group of physicians choosing an integrase strand transfer inhibitor (INSTI)-based regimen for first-line ART, the same selection criteria were identified as in the overall group; 33.3% of clinicians selected an INSTI-based regimen because of its simplicity. The presence of comorbidities was the second most frequent decisive criterion (31.0%), followed by personal experience with the prescribed ART (23.8%). In the protease inhibitor group, simplicity was also the most common selection criterion with 40%. Results of clinical trials were stated as the most important criterion for the selection of ART in 38% of all cases, followed by the expected adherence of the patient (22%). Among the physicians who used a non-nucleoside reverse transcriptase inhibitor-based regimen, patients' desire to have children was the most frequent criterion for selection of ART (60%). An ongoing pregnancy was the second most frequent selection criterion, followed by ART's simplicity (8%). For patients treated with a single-tablet regimen, simplicity of ART was comprehensibly the most important decisive criterion (54.5%). Experience with the chosen drugs was the decisive selection criterion in 24.2%, followed by comorbidities in 18.2% of cases. Physicians' selection of individual ART in patients presenting late for first-line treatment seems to be predominantly dependent on patient-centered factors such as adherence issues as well as the clinical experience of physicians with the prescribed drugs.
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Affiliation(s)
- Gundolf Schuettfort
- Department of Infectious Diseases, HIVCENTER, University Hospital Frankfurt, Frankfurt, Germany
| | - Alfonso Cabello
- Infectious Diseases Outpatient Clinic, Hospital Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Aoife G. Cotter
- Department of Infectious Diseases, HIV Molecular Research Group, UCD School of Medicine, Mater Misericordiae University Hospital, Dublin, Ireland
| | | | - Miguel Górgolas
- Infectious Diseases Outpatient Clinic, Hospital Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Madrid, Spain
| | - Lisa Hamzah
- St George's Hospital NHS Foundation Trust, London, United Kingdom
| | - Eva Herrmann
- Institute of Biostatistics and Mathematical Modelling, Goethe University Frankfurt, Frankfurt, Germany
| | - Gerrit Kann
- Department of Infectious Diseases, HIVCENTER, University Hospital Frankfurt, Frankfurt, Germany
| | | | - Alvaro Mena
- Department of Infectious Diseases, A Coruña University Hospital, A Coruña, Spain
| | - Christoph Stephan
- Department of Infectious Diseases, HIVCENTER, University Hospital Frankfurt, Frankfurt, Germany
| | - Annette E. Haberl
- Department of Infectious Diseases, HIVCENTER, University Hospital Frankfurt, Frankfurt, Germany
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Abstract
Objective: To investigate the characteristics and outcomes of people who initiated different antiretroviral therapy (ART) regimens during the era of integrase strand transfer inhibitors (INSTIs). Design: UK-based observational cohort study. Methods: UK Collaborative HIV Cohort study participants were included if they had started ART between 1 January 2012 and 30 June 2017. Virological failure was defined as the first of two consecutive plasma HIV RNA more than 50 copies/ml, at least 6 months after starting ART. Follow-up was censored at ART discontinuation, class switch or death. The risk of virological failure among those on INSTI, protease inhibitor or nonnucleoside reverse transcriptase inhibitor (NNRTI) regimens was compared using Kaplan–Meier and Cox regression methods. Results: Of 12 585 participants, 45.6% started a NNRTI, 29.0% a protease inhibitor and 25.4% an INSTI regimen. Over a median follow-up of 20.3 months (interquartile range 7.9–38.9), 7.5% of participants experienced virological failure. Compared with those starting an NNRTI regimen, people receiving INSTIs or protease inhibitors were more likely to experience virological failure: INSTI group adjusted hazard ratio 1.52, 95% confidence interval 1.19–1.95, P = 0.0009; protease inhibitor group adjusted hazard ratio 2.70, 95% confidence interval 2.27–3.21, P less than 0.0001, likelihood ratio test P less than 0.0001. Conclusion: First-line INSTI regimens were associated with a lower risk of virological failure than protease inhibitor regimens but both groups were more likely to experience virological failure than those initiating treatment with a NNRTI. There is likely to be residual channelling bias resulting from selected use of INSTIs and protease inhibitors in specific clinical contexts, including in those with a perceived risk of poor adherence.
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Gréa H, Bouchet D, Rogemond V, Hamdani N, Le Guen E, Tamouza R, Darrau E, Passerieux C, Honnorat J, Leboyer M, Groc L. Human Autoantibodies Against N-Methyl-D-Aspartate Receptor Modestly Alter Dopamine D1 Receptor Surface Dynamics. Front Psychiatry 2019; 10:670. [PMID: 31572244 PMCID: PMC6754069 DOI: 10.3389/fpsyt.2019.00670] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 08/19/2019] [Indexed: 01/03/2023] Open
Abstract
Circulating autoantibodies directed against extracellular domains of the glutamatergic N-methyl-D-aspartate receptors (NMDAR-Ab) elicit psychotic symptoms in humans and behavioral deficits in animal models. Recent advances suggest that NMDAR-Ab exert their pathogenic action by altering the trafficking of NMDAR, which results in a synaptic NMDAR hypofunction consistent with the consensual glutamatergic hypothesis of psychotic disorders. Yet, dysfunction in the dopaminergic signaling is also proposed to be at the core of psychotic disorders. Since NMDAR and dopamine D1 receptors (D1R) form membrane signaling complexes, we investigated whether NMDAR-Ab purified from patients with NMDAR-encephalitis or schizophrenia impaired D1R surface dynamics. As previous data demonstrated that NMDAR-Ab, at least from NMDAR-encephalitis patients, mainly bind to hippocampal NMDAR, we used single nanoparticle imaging to track D1R specifically at the surface of hippocampal neurons that were exposed to either purified G type immunoglobulins (IgGs) from NMDAR-Ab seropositive patients suffering from NMDAR-encephalitis or schizophrenia, or control IgGs from healthy NMDAR-Ab seropositive or seronegative subjects. We report that overnight incubation with NMDAR-Ab from patients, but not from healthy carriers, decreased the surface dynamics of D1R compared with NMDAR-Ab seronegative IgGs. This decrease was abolished, and even reversed, in D1R mutant that cannot physically interact with NMDAR. Overall, our data indicate that NMDAR-Ab from patients with psychotic symptoms alter the trafficking of D1R, likely through the surface crosstalk between NMDAR and D1R.
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Affiliation(s)
- Hélène Gréa
- Université de Bordeaux, Interdisciplinary Institute for Neuroscience, UMR 5297, Bordeaux, France.,CNRS, IINS UMR 5297, Bordeaux, France
| | - Delphine Bouchet
- Université de Bordeaux, Interdisciplinary Institute for Neuroscience, UMR 5297, Bordeaux, France.,CNRS, IINS UMR 5297, Bordeaux, France
| | - Véronique Rogemond
- NeuroMyoGene Institute, INSERM U1217/CNRS UMR 5310, Lyon, France.,French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Université de Lyon - Université Claude Bernard Lyon 1, Lyon, France
| | - Nora Hamdani
- Université Paris Est Créteil, Psychiatry Department, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, DHU PePSY, Créteil, France.,Université Paris Est Créteil, Life Science and Health Department, INSERM IMRB U955, Créteil, France.,INSERM, IMRB U955, Translational Psychiatry laboratory, Créteil, France.,FondaMental foundation, Créteil, France
| | - Emmanuel Le Guen
- Université Paris Est Créteil, Psychiatry Department, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, DHU PePSY, Créteil, France.,Université Paris Est Créteil, Life Science and Health Department, INSERM IMRB U955, Créteil, France.,INSERM, IMRB U955, Translational Psychiatry laboratory, Créteil, France.,FondaMental foundation, Créteil, France
| | - Ryad Tamouza
- Université Paris Est Créteil, Psychiatry Department, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, DHU PePSY, Créteil, France.,Université Paris Est Créteil, Life Science and Health Department, INSERM IMRB U955, Créteil, France.,INSERM, IMRB U955, Translational Psychiatry laboratory, Créteil, France.,FondaMental foundation, Créteil, France
| | - Estelle Darrau
- Université Paris Est Créteil, Life Science and Health Department, INSERM IMRB U955, Créteil, France
| | - Christine Passerieux
- FondaMental foundation, Créteil, France.,Université de Versaillles Saint Quentin en Yvelines, HandiRESP laboratory (EA4047), Health Science Department Simone Veil, Montigny le Bretonneux, France.,Versailles Hospital, Department of Adult Psychiatry, Le Chesnay, France
| | - Jérôme Honnorat
- NeuroMyoGene Institute, INSERM U1217/CNRS UMR 5310, Lyon, France.,French Reference Center of Paraneoplastic Neurological Syndrome, Hospices Civils de Lyon, Hôpital Neurologique, Lyon, France.,Université de Lyon - Université Claude Bernard Lyon 1, Lyon, France
| | - Marion Leboyer
- Université Paris Est Créteil, Psychiatry Department, Groupe Hospitalier Universitaire Henri Mondor, AP-HP, DHU PePSY, Créteil, France.,Université Paris Est Créteil, Life Science and Health Department, INSERM IMRB U955, Créteil, France.,INSERM, IMRB U955, Translational Psychiatry laboratory, Créteil, France.,FondaMental foundation, Créteil, France
| | - Laurent Groc
- Université de Bordeaux, Interdisciplinary Institute for Neuroscience, UMR 5297, Bordeaux, France.,CNRS, IINS UMR 5297, Bordeaux, France
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Hartzler B, Dombrowski JC, Williams JR, Crane HM, Eron JJ, Geng EH, Mathews C, Mayer KH, Moore RD, Mugavero MJ, Napravnik S, Rodriguez B, Donovan DM. Influence of Substance Use Disorders on 2-Year HIV Care Retention in the United States. AIDS Behav 2018; 22:742-751. [PMID: 28612213 PMCID: PMC5729068 DOI: 10.1007/s10461-017-1826-2] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Substance use disorders (SUDs) are thought to predict care discontinuity, though magnitude and substance-specific variance of effects are unclear. This report of analytic work undertaken with a multi-regional American cohort of 9153 care enrollees addresses these gaps. Care retention was computed from 24-month post-linkage clinic visit documentation, with SUD cases identified from patient-report screening instruments. Two generalized estimating equations tested binary and hierarchial SUD predictors of retention, and potential effect modification by patient age-group, sex, and care site. Findings demonstrate: (1) detrimental SUD effect, equivalent to a nine percentage-point decrease in retention, with independent effects of age-group and care site; (2) substance-specific effect of marijuana UD associated with lower retention; and (3) age-modification of each effect on care discontinuity, with SUDs serving as a risk factor among 18-29 year-olds and protective factor among 60+ year-olds. Collective findings document patient attributes as influences that place particular subgroups at-risk to discontinue care.
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Affiliation(s)
- Bryan Hartzler
- Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA.
| | - Julia C Dombrowski
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Jason R Williams
- Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA
| | - Heidi M Crane
- Division of Allergy and Infectious Disease, University of Washington, Seattle, WA, USA
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
- Department of Epidemiology, University of North Carolina, Chapel Hill, NC, USA
| | - Elvin H Geng
- School of Medicine, University of California, San Francisco, CA, USA
| | | | - Kenneth H Mayer
- School of Medicine, Harvard University, Boston, MA, USA
- School of Public Health, Harvard University, Boston, MA, USA
| | - Richard D Moore
- Department of Medicine, Johns Hopkins University, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins University, Baltimore, MD, USA
- Center for Global Health, Johns Hopkins University, Baltimore, MD, USA
| | | | - Sonia Napravnik
- Department of Medicine, University of North Carolina, Chapel Hill, NC, USA
| | - Benigno Rodriguez
- Department of Medicine, Case Western Reserve University, Cleveland, OH, USA
| | - Dennis M Donovan
- Alcohol & Drug Abuse Institute, University of Washington, 1107 NE 45th Street Suite 120, Box 354805, Seattle, WA, 98105-4631, USA
- Psychiatry and Behavioral Sciences, University of Washington, Seattle, WA, USA
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6
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Cole SR, Edwards JK, Hall HI, Brookhart MA, Mathews WC, Moore RD, Crane HM, Kitahata MM, Mugavero MJ, Saag MS, Eron JJ. Incident AIDS or Death After Initiation of Human Immunodeficiency Virus Treatment Regimens Including Raltegravir or Efavirenz Among Adults in the United States. Clin Infect Dis 2018; 64:1591-1596. [PMID: 28498892 DOI: 10.1093/cid/cix199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2016] [Accepted: 02/16/2017] [Indexed: 12/20/2022] Open
Abstract
Background. The long-term effectiveness of human immunodeficiency virus (HIV) treatments containing integrase inhibitors is unknown. Methods. We use observational data from the Centers for AIDS Research Network of Integrated Clinical Systems and the Centers for Disease Control and Prevention to estimate 4-year risk of AIDS and all-cause mortality among 415 patients starting a raltegravir regimen compared to 2646 starting an efavirenz regimen (both regimens include emtricitabine and tenofovir disoproxil fumarate). We account for confounding and selection bias as well as generalizability by standardization for measured variables, and present both observational intent-to-treat and per-protocol estimates. Results. At treatment initiation, 12% of patients were female, 36% black, 13% Hispanic; median age was 37 years, CD4 count 321 cells/µL, and viral load 4.5 log10 copies/mL. Two hundred thirty-five patients incurred an AIDS-defining illness or died, and 741 patients left follow-up. After accounting for measured differences, the 4-year risk was similar among those starting both regimens (ie, intent-to treat hazard ratio [HR], 0.96 [95% confidence interval {CI}, .63-1.45]; risk difference, -0.9 [95% CI, -4.5 to 2.7]), as well as among those remaining on regimens (ie, per-protocol HR, 0.95 [95% CI, .59-1.54]; risk difference, -0.5 [95% CI, -3.8 to 2.9]). Conclusions. Raltegravir and efavirenz-based initial antiretroviral therapy have similar 4-year clinical effects. Vigilance regarding longer-term comparative effectiveness of HIV regimens using observational data is needed because large-scale experimental data are not forthcoming.
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Affiliation(s)
- Stephen R Cole
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - Jessie K Edwards
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | - H Irene Hall
- Division of HIV/AIDS Prevention, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - M Alan Brookhart
- Department of Epidemiology, University of North Carolina, Chapel Hill
| | | | - Richard D Moore
- Department of Medicine, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Heidi M Crane
- Department of Medicine, University of Washington, Seattle
| | | | | | - Michael S Saag
- Department of Medicine, University of Alabama at Birmingham; and
| | - Joseph J Eron
- Department of Medicine, University of North Carolina, Chapel Hill
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