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Durability of different initial regimens in HIV-infected patients starting antiretroviral therapy with CD4+ counts <200 cells/mm3 and HIV-RNA >5 log10 copies/mL

2019; Oxford University Press; Volume: 74; Issue: 9 Linguagem: Inglês

10.1093/jac/dkz237

1460-2091

Nicola Gianotti, P Lorenzini, Alessandro Cozzi‐Lepri, Andrea De Luca, Giordano Madeddu, Laura Sighinolfi, Carmela Pinnetti, Carmen Rita Santoro, Paola Meraviglia, Cristina Mussini, Andrea Antinori, Antonella d’Arminio Monforte, Antonella d’Arminio Monforte, Massimo Andreoni, Gioacchino Angarano, Andrea Antinori, Francesco Castelli, Roberto Cauda, Giovanni Di Perri, Massimo Galli, Rosaria Iardino, Giuseppe Ippolito, Adriano Lazzarin, Carlo Federico Perno, F von Schloesser, Pierluigi Viale, Antonella d’Arminio Monforte, Andrea Antinori, Antonella Castagna, Francesca Ceccherini‐Silberstein, Alessandro Cozzi‐Lepri, Enrico Girardi, Sergio Lo Caputo, Cristina Mussini, Massimo Puoti, Massimo Andreoni, Adriana Ammassari, Andrea Antinori, Claudia Balotta, Alessandra Bandera, P Bonfanti, Stefano Bonora, Marco Borderi, Andrea Calcagno, Leonardo Calza, Maria Rosaria Capobianchi, Antonella Castagna, Francesca Ceccherini‐Silberstein, A. Cingolani, Paola Cinque, Alessandro Cozzi‐Lepri, Antonella d’Arminio Monforte, Andrea De Luca, Antonio Di Biagio, Enrico Girardi, Nicola Gianotti, Andrea Gori, Giovanni Guaraldi, Giuseppe Lapadula, Miriam Lichtner, Sergio Lo Caputo, Giordano Madeddu, Franco Maggiolo, Giulia Marchetti, S Marcotullio, Laura Monno, Cristina Mussini, Silvia Nozza, Massimo Puoti, Eugenia Quirós-Roldán, Roberto Rossotti, Stefano Rusconi, Maria Mercedes Santoro, Annalisa Saracino, Mauro Zaccarelli, Alessandro Cozzi‐Lepri, Iuri Fanti, Letizia Galli, P Lorenzini, A Rodano, Milensu Shanyinde, A Tavelli, Fabrizio Carletti, Silvia Carrara, Antonino Di, Silvia Graziano, Fabrizio Petrone, Gennaro Prota, Serena Quartu, S Truffa, Andrea Giacometti, Andrea Costantini, Chiara Valeriani, Gioacchino Angarano, Laura Monno, Carmen Rita Santoro, Franco Maggiolo, Claudia Suardi, Pierluigi Viale, Valentina Donati, Gabriella Verucchi, Francesco Castelli, E Quirós, C Minardi, Tiziana Quirino, C Abeli, P E Manconi, P Piano, Bruno Cacopardo, Benedetto Maurizio Celesia, Jacopo Vecchiet, Katia Falasca, L Sighinolfi, Daniela Segala, Francesco Mazzotta, Francesca Vichi, Giovanni Cassola, Claudio Viscoli, A. Alessandrini, Nicoletta Bobbio, Giovanni Mazzarello, Claudio Maria Mastroianni, Valeria Belvisi, P Bonfanti, Ilaria Caramma, Alessandro Chiodera, Francesco Castelli, Massimo Galli, Adriano Lazzarin, Giuliano Rizzardini, Massimo Puoti, Antonella d’Arminio Monforte, Anna Lisa Ridolfo, R. Piolini, Antonella Castagna, Stefania Salpietro, Laura Carenzi, M C Moioli, Camilla Tincati, Giulia Marchetti, Cristina Mussini, Cinzia Puzzolante, Andrea Gori, Giuseppe Lapadula, N Abrescia, Antonio Chirianni, Guglielmo Borgia, Federica Martino, L Maddaloni, Ivan Gentile, R. Orlando, F Baldelli, Daniela Francisci, Giustino Parruti, Tamara Ursini, G. Magnani, M A Ursitti, Roberto Cauda, Massimo Andreoni, Andrea Antinori, Vincenzo Vullo, Alfonso Cristaudo, A. Cingolani, Gianmaria Baldin, Stefania Cicalini, L Gallo, Emanuele Nicastri, R Acinapura, M Capozzi, Raffaella Libertone, Stefano Savinelli, Alessandra Latini, M Cecchetto, Franco Viviani, Matteo Mura, Giordano Madeddu, Andrea De Luca, Barbara Rossetti, P Caramello, Giovanni Di Perri, Giancarlo Orofino, Stefano Bonora, Mauro Sciandra, Matteo Bassetti, Alejandra Londero, G. Pellizzer, Vinicio Manfrin,

HIV Research and Treatment

Our aim was to investigate the durability of different initial regimens in patients starting ART with CD4+ counts 5 log10 copies/mL.This was a retrospective study of HIV-infected patients prospectively followed in the ICONA cohort. Those who started ART with boosted protease inhibitors (bPIs), NNRTIs or integrase strand transfer inhibitors (InSTIs), with CD4+ 5 log10 copies/mL, were included. The primary endpoint was treatment failure (TF), a composite endpoint defined as virological failure (VF, first of two consecutive HIV-RNA >50 copies/mL after 6 months of treatment), discontinuation of class of the anchor drug or death. Independent associations were investigated by Poisson regression analysis in a model including age, gender, mode of HIV transmission, CDC stage, HCV and HBV co-infection, pre-treatment HIV-RNA, CD4+ count and CD4+/CD8+ ratio, ongoing opportunistic disease, fibrosis FIB-4 index, estimated glomerular filtration rate, haemoglobin, platelets, neutrophils, calendar year of ART initiation, anchor drug class (treatment group) and nucleos(t)ide backbone.A total of 1195 patients fulfilled the inclusion criteria: 696 started ART with a bPI, 315 with an InSTI and 184 with an NNRTI. During 2759 person-years of follow up, 642 patients experienced TF. Starting ART with bPIs [adjusted incidence rate ratio (aIRR) (95% CI) 1.62 (1.29-2.03) versus starting with NNRTIs; P < 0.001] and starting ART with InSTIs [aIRR (95% CI) 0.68 (0.48-0.96) versus starting with NNRTIs; P = 0.03] were independently associated with TF.In patients starting ART with 5 log10 HIV-RNA copies/mL, the durability of regimens based on InSTIs was longer than that of NNRTI- and bPI-based regimens.