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Kubicka J, Gizińska J, Kowalska J, Siwak E, Swiecki P, Pulik P, Szulborska B, Burkacka-Firlag E, Horban A. Efavirenz as component of initial combination antiretroviral therapy – Data from the Polish Observational Cohort of HIV/AIDS Patients (POLCA) Study Group. HIV & AIDS REVIEW 2016. [DOI: 10.1016/j.hivar.2016.04.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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Jones D, Cook R, Cecchini D, Sued O, Bofill L, Weiss S, Waldrop-Valverde D, Lopez MR, Spence A. Examining Adherence Among Challenging Patients in Public and Private HIV Care in Argentina. AIDS Behav 2015; 19:1619-29. [PMID: 25777507 DOI: 10.1007/s10461-015-1037-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Treatment engagement, retention and adherence to care are required for optimal HIV outcomes. Yet, patients may fall below the treatment recommendations for achieving undetectable viral load or not be retained in care. This study examined the most challenging patients in Buenos Aires, Argentina, those non-adherent to HIV care. Men (n = 61) and women (n = 59) prescribed antiretrovirals (ARVs) and non-adherent to treatment in the prior 3-6 months were enrolled and assessed regarding adherence, knowledge, motivation and attitudes regarding treatment. Private clinic patients had lower viral load and higher self-reported adherence than public clinic patients. Motivations to be adherent and positive beliefs regarding ARVs were associated with increased adherence in public clinic participants. Increased self-efficacy was associated with increased adherence among participants from both clinics. Results support patient and provider interventions that strengthen the characteristics supporting adherence, engagement and retention in public and private clinic settings.
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Affiliation(s)
- Deborah Jones
- Department of Psychiatry & Behavioral Sciences, University of Miami Miller School of Medicine, 1400 NW 10th Ave., Miami, FL, 33136, USA,
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Podlekareva D, Grint D, Karpov I, Rakmanova A, Mansinho K, Chentsova N, Zeltina I, Losso M, Parczewski M, Lundgren JD, Mocroft A, Kirk O. Changing utilization of Stavudine (d4T) in HIV-positive people in 2006-2013 in the EuroSIDA study. HIV Med 2015; 16:533-43. [PMID: 25988795 DOI: 10.1111/hiv.12254] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/03/2015] [Indexed: 11/30/2022]
Abstract
OBJECTIVES The long-term side effects of stavudine (d4T) led to recommendations in 2009 to phase out use of this drug. We aimed to describe temporal patterns of d4T use across Europe. METHODS Patients taking combination antiretroviral therapy (cART) in EuroSIDA with follow-up after 1 January 2006 were included in the study. cART was defined as d4T-containing [d4T plus at least two other antiretrovirals (ARVs) from any class] or non-d4T-containing (at least three ARVs from any class, excluding d4T). Poisson regression was used to describe temporal changes in the prevalence of d4T use and factors associated with initiating d4T. RESULTS A total of 5850 patients receiving cART on 1 January 2006 were included in the current analysis, rising to 7768 patients on January 1 2013. During this time, the prevalence of d4T use fell from 11.2% to 0.7%, with an overall decline of 19% per 6 months [95% confidence interval (CI) 19-20%]. d4T use declined fastest in Northern Europe [26% (95% CI 23-29%) per 6 months], and slowest in Eastern Europe [17% (95% CI 16-19%) per 6 months]. In multivariable Poisson regression models, new d4T initiations decreased by 14% per 6 months [adjusted incidence rate ratio (aIRR) 0.86; 95% CI 0.80-0.91]. Factors associated with initiating d4T were residence in Eastern Europe (aIRR 4.31; 95% CI 2.17-9.98) versus other European regions and HIV RNA > 400 copies/mL (aIRR 3.11; 95% CI 1.60-6.02) versus HIV RNA < 400 copies/mL. CONCLUSIONS d4T use has declined sharply since 2006 to low levels in most regions; however, a low but persistent level of d4T use remains in Eastern Europe, where new d4T initiations post 2006 are also more common. The reasons for the regional differences may be multifactorial, but it is important to ensure that all clinicians treating HIV-positive patients are aware of the potential harmful effects associated with d4T.
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Affiliation(s)
- D Podlekareva
- CHIP, Department of Infectious Diseases Rigshospitalet, University of Copenhagen, Denmark
| | - D Grint
- UCL - Royal Free Campus, London, UK
| | - I Karpov
- Belarus State Medical University, Minsk, Belarus
| | - A Rakmanova
- Medical Academy Botkin Hospital, St Petersburg, Russia
| | - K Mansinho
- Hospital de Egas Moniz, Lisbon, Portugal
| | | | - I Zeltina
- Riga East University Hospital, Latvian Centre of Infectious Diseases, Riga, Latvia
| | - M Losso
- HIV Unit, Hospital JM Ramos Mejia, Buenos Aires, Argentina
| | | | - J D Lundgren
- CHIP, Department of Infectious Diseases Rigshospitalet, University of Copenhagen, Denmark
| | | | - O Kirk
- CHIP, Department of Infectious Diseases Rigshospitalet, University of Copenhagen, Denmark
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Calendar time trends in the incidence and prevalence of triple-class virologic failure in antiretroviral drug-experienced people with HIV in Europe. J Acquir Immune Defic Syndr 2012; 59:294-9. [PMID: 22083070 DOI: 10.1097/qai.0b013e31823fe66b] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Abstract
BACKGROUND Despite the increasing success of antiretroviral therapy (ART), virologic failure of the 3 original classes [triple-class virologic failure, (TCVF)] still develops in a small minority of patients who started therapy in the triple combination ART era. Trends in the incidence and prevalence of TCVF over calendar time have not been fully characterised in recent years. METHODS Calendar time trends in the incidence and prevalence of TCVF from 2000 to 2009 were assessed in patients who started ART from January 1, 1998, and were followed within the Collaboration of Observational HIV Epidemiological Research Europe (COHERE). RESULTS Of 91,764 patients followed for a median (interquartile range) of 4.1 (2.0-7.1) years, 2722 (3.0%) developed TCVF. The incidence of TCVF increased from 3.9 per 1000 person-years of follow-up [95% confidence interval (CI): 3.7 to 4.1] in 2000 to 8.8 per 1000 person-years of follow-up (95% CI: 8.5 to 9.0) in 2005, but then declined to 5.8 per 1000 person-years of follow-up (95% CI: 5.6 to 6.1) by 2009. The prevalence of TCVF was 0.3% (95% CI: 0.27% to 0.42%) at December 31, 2000, and then increased to 2.4% (95% CI: 2.24% to 2.50%) by the end of 2005. However, since 2005, TCVF prevalence seems to have stabilized and has remained below 3%. CONCLUSIONS The prevalence of TCVF in people who started ART after 1998 has stabilized since around 2005, which most likely results from the decline in incidence of TCVF from this date. The introduction of improved regimens and better overall HIV care is likely to have contributed to these trends. Despite this progress, calendar trends should continue to be monitored in the long term.
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Developing a multidisciplinary network for clinical research on HIV infection: the EuroCoord experience. ACTA ACUST UNITED AC 2012. [DOI: 10.4155/cli.12.3] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Pour SM, Woolley I, Canavan P, Chuah J, Russell DB, Law M, Petoumenos K. Triple class experience after initiation of combination antiretroviral treatment in Australia: survival and projections. Sex Health 2011; 8:295-303. [PMID: 21851768 DOI: 10.1071/sh10008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2010] [Accepted: 10/29/2010] [Indexed: 11/23/2022]
Abstract
BACKGROUND Patients who have become triple class experienced (TCE) are at a high risk of exhausting available treatment options. This study aims to investigate factors associated with becoming TCE and to explore the effect of becoming TCE on survival. We also project the prevalence of TCE in Australia to 2012. METHODS Patients were defined as TCE when they stopped a combination antiretroviral treatment (cART) that introduced the third of the three major antiretroviral classes. Cox proportional hazards models were used to investigate factors associated with TCE and the effect of TCE on survival. To project TCE prevalence, we used predicted rates of TCE by fitting a Poisson regression model, together with the estimated number of patients who started cART in each year in Australia, assuming a mortality rate of 1.5 per 100 person-years. RESULTS Of the 1498 eligible patients, 526 became TCE. Independent predictors of a higher risk of TCE included current CD4 counts below 200cellsμL(-1) and earlier calendar periods. No significant difference in survival was observed between those who were TCE and those who were not yet TCE. An increasing number of patients are using cART in Australia and if current trends continue, the number of patients who are TCE is estimated to increase from 2800 in 2003 to 5000 in 2012. CONCLUSION Our results suggest that the prevalence of TCE in Australia is estimated to plateau after 2003. However, as an increasing number of patients are becoming TCE, it is necessary to develop new drugs that come from new classes or do not have overlapping resistance.
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Affiliation(s)
- Sadaf Marashi Pour
- National Centre in HIV Epidemiology and Clinical Research, University of New South Wales, Sydney, NSW 2052, Australia.
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Lodwick R, Costagliola D, Reiss P, Torti C, Teira R, Dorrucci M, Ledergerber B, Mocroft A, Podzamczer D, Cozzi-Lepri A, Obel N, Masquelier B, Staszewski S, García F, De Wit S, Castagna A, Antinori A, Judd A, Ghosn J, Touloumi G, Mussini C, Duval X, Ramos J, Meyer L, Warsawski J, Thorne C, Masip J, Pérez-Hoyos S, Pillay D, van Sighem A, Lo Caputo S, Günthard H, Paredes R, De Luca A, Paraskevis D, Fabre-Colin C, Kjaer J, Chêne G, Lundgren JD, Phillips AN. Triple-class virologic failure in HIV-infected patients undergoing antiretroviral therapy for up to 10 years. ARCHIVES OF INTERNAL MEDICINE 2010; 170:410-9. [PMID: 20212176 PMCID: PMC3319528 DOI: 10.1001/archinternmed.2009.472] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
BACKGROUND Life expectancy of people with human immunodeficiency virus (HIV) is now estimated to approach that of the general population in some successfully treated subgroups. However, to attain these life expectancies, viral suppression must be maintained for decades. METHODS We 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. We also focused on TCVF in patients who started a PI/r-containing regimen after a first-line NNRTI-containing regimen failed. RESULTS Of 45 937 patients followed up for a median (interquartile range) of 3.0 (1.5-5.0) years, 980 developed TCVF (2.1%). By 5 and 9 years after starting ART, an estimated 3.4% (95% confidence interval [CI], 3.1%-3.6%) and 8.6% (95% CI, 7.5%-9.8%) 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 (P = .11). By 5 years after starting a PI/r regimen as second-line therapy, 46% of patients had developed TCVF. CONCLUSIONS 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.
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Bansi L, Sabin C, Delpech V, Hill T, Fisher M, Walsh J, Chadborn T, Easterbrook P, Gilson R, Johnson M, Porter K, Anderson J, Gompels M, Leen C, Ainsworth J, Orkin C, Nelson M, Rice B, Phillips A. Trends over calendar time in antiretroviral treatment success and failure in HIV clinic populations. HIV Med 2010; 11:432-8. [PMID: 20146736 DOI: 10.1111/j.1468-1293.2009.00809.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Effective antiretroviral therapy (ART) has transformed the care of people with HIV, but it is important to monitor time trends in indicators of treatment success and antic future changes. METHODS We assessed time trends from 2000 to 2007 in several indicators of treatment success in the UK Collaborative HIV Cohort (CHIC) Study, and using national HIV data from the Health Protection Agency (HPA) we developed a model to project future trends. RESULTS The proportion of patients on ART with a viral load <50 HIV-1 RNA copies/mL increased from 62% in 2000 to 84% in 2007, and the proportion of all patients with a CD4 count <200 cells/microL decreased from 21% to 10%. During this period, the number of patients who experienced extensive triple class failure (ETCF) rose from 147 (0.9%) to 1771 (3.9%). The number who experienced such ETCF and had a current viral load >50 copies/mL rose fromz 118 (0.7%) to 857 (1.9%). Projections to 2012 suggest sustained high levels of success, with a continued increase in the number of patients who have failed multiple drugs but a relatively stable number of such patients experiencing viral loads >50 copies/mL. Numbers of deaths are projected to remain low. CONCLUSIONS There have been continued improvements in key indicators of success in patients with HIV from 2000 to 2007. Although the number of patients who have ETCF is projected to rise in the future, the number of such patients with viral loads >50 copies/mL is not projected to increase up to 2012. New drugs may be needed in future to sustain these positive trends.
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Affiliation(s)
- L Bansi
- UCL Medical School, Royal Free Campus, London, UK.
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Podlekareva D, Bannister W, Mocroft A, Abrosimova L, Karpov I, Lundgren JD, Kirk O. The EuroSIDA Study: Regional Differences in the HIV-1 Epidemic and Treatment Response to Antiretroviral Therapy among HIV-infected Patients across Europe - A Review of Published Results. Cent Eur J Public Health 2008; 16:99-105. [DOI: 10.21101/cejph.a3490] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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