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Titolo:
Comparison of virologic, immunologic, and clinical response to five different initial protease inhibitor-containing and nevirapine-containing regimens
Autore:
Easterbrook, PJ; Newson, R; Ives, N; Pereira, S; Moyle, G; Gazzard, BG;
Indirizzi:
Univ London Kings Coll Hosp, Dept HIV & Genitourinary Med, Guys Kings & StThomas Sch Med, Weston Educ Ctr, London SE5 9RT, England Univ London Kings Coll Hosp London England SE5 9RT ndon SE5 9RT, England Guys Hosp, Dept Publ Hlth Sci, Guys Kings & St Thomas Sch Med, London SE1 9RT, England Guys Hosp London England SE1 9RT Thomas Sch Med, London SE1 9RT, England Chelsea & Westminster Hosp, Dept Immunol, London, England Chelsea & Westminster Hosp London England Dept Immunol, London, England Chelsea & Westminster Hosp, Kobler Clin, London, England Chelsea & Westminster Hosp London England Kobler Clin, London, England
Titolo Testata:
JOURNAL OF ACQUIRED IMMUNE DEFICIENCY SYNDROMES
fascicolo: 4, volume: 27, anno: 2001,
pagine: 350 - 364
SICI:
1525-4135(20010801)27:4<350:COVIAC>2.0.ZU;2-J
Fonte:
ISI
Lingua:
ENG
Soggetto:
ACTIVE ANTIRETROVIRAL THERAPY; IMMUNODEFICIENCY-VIRUS INFECTION; TRIPLE-DRUG THERAPY; PLASMA HIV RNA; CONTROLLED TRIAL; PLUS INDINAVIR; FAILURE; ZIDOVUDINE; PREDICTORS; COHORT;
Keywords:
AIDS; antiretroviral therapy; HIV; HIV RNA; protease inhibitors; treatment failure; viral load;
Tipo documento:
Article
Natura:
Periodico
Settore Disciplinare:
Clinical Medicine
Life Sciences
Citazioni:
40
Recensione:
Indirizzi per estratti:
Indirizzo: Easterbrook, PJ Univ London Kings Coll Hosp, Dept HIV & Genitourinary Med,Guys Kings & StThomas Sch Med, Weston Educ Ctr, Cutcombe Rd,Denmark Hill Campus, London SE5 9RT, England Univ London Kings Coll Hosp Cutcombe Rd,Denmark Hill Campus London England SE5 9RT
Citazione:
P.J. Easterbrook et al., "Comparison of virologic, immunologic, and clinical response to five different initial protease inhibitor-containing and nevirapine-containing regimens", J ACQ IMM D, 27(4), 2001, pp. 350-364

Abstract

Context: The effectiveness of different protease inhibitors (PIs) and non-nucleoside reverse transcriptase inhibitors outside the setting of clinicaltrials has not been well described. Objectives: To compare five different PI- and nevirapine (NVP)-containing regimens on virologic, immunologic, and clinical outcomes and treatment discontinuation. Design and Setting: Observational cohort study based on an HIV clinic in London. Patients: A total of 690 patients who received either saquinavir hard gel (SQV HG) (n = 183), indinavir (IDV) (n = 189). nelfinavir (NFV) (n = 109), ritonavir (RTV) (n = 42), ritonavir with saquinavir hard gel (RTV/SQV HG) (n = 45), or NVP (n = 122) as part of an initial PI- or NVP-containing treatment regimen between November 1994 and December 1998. A total of 351 (51%) patients had prior exposure to nucleoside reverse transcriptase inhibitors (NRTIs). Main Outcome Measures: The main outcome measures were virologic undetectability, subsequent virologic rebound, CD4 cell count rise, development of AIDS, and treatment discontinuation. All analyses were stratified for year ofinitiation of the PI-or NVP-containing regimen. Results: Overall, 63% of patients attained an undetectable viral load (VL)within 6 months of starting their PI or NVP regimen. The adjusted relativehazard (95% confidence interval [CII) for an undetectable VL relative to SQV HG was (in rank order): 2.77 (CI: 1.84-4.17) for NFV. 2.54 (CL 1.81-3.57) for IDV, 2.43 (CI: 1.52-3.87) for RTV 2.08 (CI: 1.28-3.37) for RTV/SQV HG. and 1.96 (CI: 1.35-2.85) for NVP. Forty-nine percent of patients experienced VL rebound within 12 months of initial attainment of undetectability, but relative to SQV HG. this did not differ significantly across the different PI and NVP regimens. The CD4 cell count response and rate of AIDS eventswere also similar across the different regimens. No independent predictorsof VL undetectability were identified, but prior NRTI exposure was associated with VL rebound. and a lower baseline VL and CD4 cell count were associated with a reduced CD4 count response. The frequency (95% CI) of treatmentdiscontinuation differed across the regimens at 6 months, it was lowest for NFV (18% [CI: 13%-24%]), IDV (25% [CI: 22%-29%]), and NVP (28% [CI: 22%-34%]) and highest for RTV (41% [CI: 31%-52%]) and SQV HG (52% [CI: 48%-57%]). Conclusions: Although PI- and NVP-containing regimens were similar in their CD4 cell count response and rates of subsequent VL rebound, differences were observed in time to VL undetectability and discontinuation rates relative to SQV HG. SQV HG was consistently inferior to the other PIs and NVP. The use of NFV and IDV was associated with the highest rates of undetectability. and together with NVP. the lowest rates of discontinuation.

ASDD Area Sistemi Dipartimentali e Documentali, Università di Bologna, Catalogo delle riviste ed altri periodici
Documento generato il 02/04/20 alle ore 09:33:59