Format

Send to

Choose Destination
J Int AIDS Soc. 2017 Jul 17;20(1):21847. doi: 10.7448/IAS.20.1.21847.

Meeting the WHO 90% target: antiretroviral treatment efficacy in Poland is associated with baseline clinical patient characteristics.

Author information

1
Pomeranian Medical University, Department of Infectious, Tropical Diseases and Immune Deficiency, Szczecin, Poland.
2
Hospital for Infectious Diseases, HIV Out-Patient's Clinic, Warsaw, Poland.
3
Regional Hospital, Out-Patient's Clinic for Immune Deficiency, Chorzów, Poland.
4
Department of Infectious Diseases and Hepatology, Medical University of Białystok, Białystok, Poland.
5
Department of Infectious Diseases, Medical University of Gdańsk, Gdańsk, Poland.
6
Department of Infectious Diseases and Hepatology Nicolaus Copernicus University Ludwik Rydygier Collegium Medicum in Bydgoszcz, Faculty of Medicine, Bydgoszcz, Poland.
7
Department of Infectious Diseases, Liver Disease and Acquired Immune Deficiencies, Wroclaw Medical University, Wrocław, Poland.
8
Department of Infectious Diseases, Jagiellonian University Medical College, Kraków, Poland.
9
Department of Infectious Diseases and Hepatology, Medical University of Łódź, Łódź, Poland.
10
Department of Infectious and Tropical Diseases and Hepatology, Medical University in Warsaw, Warsaw, Poland.
11
Department of Infectious Diseases, Regional Hospital in Zielona Góra, Zielona Góra, Poland.
12
Department of Infectious Diseases, Medical University in Lublin, Lublin, Poland.
13
Clinical Division of Infectious Diseases, University of Warmia and Mazury in Olsztyn, Olsztyn, Poland.
14
Department of Infectious Diseases, Regional Hospital, Opole, Poland.
15
Department for Adults Infectious Diseases, Medical University of Warsaw, Warsaw, Poland.

Abstract

INTRODUCTION:

Modern combined antiretroviral therapies (cART) allow to effectively suppress HIV-1 viral load, with the 90% virologic success rate, meeting the WHO target in most clinical settings. The aim of this study was to analyse antiretroviral treatment efficacy in Poland and to identify variables associated with virologic suppression.

M:

ethods Cross-sectional data on 5152 (56.92% of the countrywide treated at the time-point of analysis) patients on cART for more than six months with at least one HIV-RNA measurement in 2016 were collected from 14 Polish centres. Patients' characteristics and treatment type-based outcomes were analysed for the virologic suppression thresholds of <50 and <200 HIV-RNA copies/ml. CART was categorized into two nucleos(t)ide (2NRTI) plus non-nucleoside reverse transcriptase (NNRTI) inhibitors, 2NRTI plus protease (PI) inhibitor, 2NRTI plus integrase (InI) inhibitor, nucleos(t)ide sparing PI/r+InI and three drug class regimens. For statistics Chi-square and U-Mann Whitney tests and adjusted multivariate logistic regression models were used.

RESULTS:

Virologic suppression rates of <50 copies/mL were observed in 4672 (90.68%) and <200 copies/mL in 4934 (95.77%) individuals. In univariate analyses, for the suppression threshold <50 copies/mL higher efficacy was noted for 2NRTI+NNRTI-based combinations (94.73%) compared to 2NRTI+PI (89.93%), 2NRTI+InI (90.61%), nucleos(t)ide sparing PI/r+InI (82.02%) and three drug class regimens (74.49%) (p < 0.0001), with less pronounced but significant differences for the threshold of 200 copies/mL [2NRTI+NNRTI-97.61%, 2NRTI+PI-95.27%, 2NRTI+InI-96.61%, PI/r+InI- 95.51% and 86.22% for three drug class cART) (p < 0.0001). However, in multivariate model, virologic efficacy for viral load <50 copies/mL was similar across treatment groups with significant influence by history of AIDS [OR:1.48 (95%CI:1.01-2.17) if AIDS diagnosed, p = 0.046], viral load < 5 log copies/mL at care entry [OR:1.47 (95%CI:1.08-2.01), p = 0.016], baseline lymphocyte CD4 count ≥200 cells/µL [OR:1.72 (95%CI:1.04-2.78), p = 0.034] and negative HCV serology [OR:1.97 (95%CI:1.29-2.94), p = 0.002]. For viral load threshold <200 copies/mL higher likelihood of virologic success was only associated with baseline lymphocyte CD4 count ≥200 cells/µL [OR:2.08 (95%CI:1.01-4.35), p = 0.049] and negative HCV status [OR:2.84 (95%CI:1.52-5.26), p = 0.001].

CONCLUSIONS:

Proportion of virologically suppressed patients is in line with WHO treatment target confirming successful application of antiretroviral treatment strategy in Poland. Virological suppression rates depend on baseline patient characteristics, which should guide individualized antiretroviral tre0atment decisions.

KEYWORDS:

WHO target; antiretroviral treatment; cART efficacy; viral replication; virologic control; virologic suppression

PMID:
28715160
PMCID:
PMC5577695
DOI:
10.7448/IAS.20.1.21847
[Indexed for MEDLINE]
Free PMC Article

Supplemental Content

Full text links

Icon for Wiley Icon for PubMed Central
Loading ...
Support Center