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AIDS. 2018 Jan 28;32(3):327-335. doi: 10.1097/QAD.0000000000001692.

Effect of immediate initiation of antiretroviral treatment on the risk of acquired HIV drug resistance.

Author information

1
Harvard T.H. Chan School of Public Health, Boston, Massachusetts, USA.
2
Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich.
3
Institute of Medical Virology, University of Zurich, Zurich, Switzerland.
4
University College London, London, UK.
5
Universidad de Granada, Granada, Spain.
6
Basel Institute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel.
7
Department of Ambulatory Care and Community Medicine, University of Lausanne, Lausanne.
8
Community Pharmacy, School of Pharmaceutical Sciences, University of Geneva, Geneva.
9
Institute of Social and Preventive Medicine, University of Bern, Bern.
10
Swiss Tropical and Public Health Institute.
11
University of Basel, Basel, Switzerland.
12
Stichting HIV Monitoring.
13
Division of Infectious Diseases, Department of Global Health, Academic Medical Centre, University of Amsterdam.
14
Amsterdam Institute for Global Health and Development, Amsterdam, the Netherlands.
15
Chelsea and Westminster Hospital, London, UK.
16
IRYCIS, Ramón y Cajal Hospital.
17
University of Alcalá de Henares.
18
National Centre of Epidemiology - ISCIII, Madrid, Spain.
19
National and Kapodistrian University of Athens Medical School, Athens.
20
Aristotle University of Thessaloniki, Thessaloniki, Greece.
21
Harvard-MIT Division of Health Sciences and Technology, Boston, Massachusetts, USA.

Abstract

OBJECTIVE:

We estimated and compared the risk of clinically identified acquired drug resistance under immediate initiation [the currently recommended antiretroviral therapy (ART) initiation strategy], initiation with CD4 cell count less than 500 cells/μl and initiation with CD4 cell count less than 350 cells/μl.

DESIGN:

Cohort study based on routinely collected data from the HIV-CAUSAL collaboration.

METHODS:

For each individual, baseline was the earliest time when all eligibility criteria (ART-naive, AIDS free, and others) were met after 1999. Acquired drug resistance was defined using the Stanford classification as resistance to any antiretroviral drug that was clinically identified at least 6 months after ART initiation. We used the parametric g-formula to adjust for time-varying (CD4 cell count, HIV RNA, AIDS, ART regimen, and drug resistance testing) and baseline (calendar period, mode of acquisition, sex, age, geographical origin, ethnicity and cohort) characteristics.

RESULTS:

In 50 981 eligible individuals, 10% had CD4 cell count more than 500 cells/μl at baseline, and 63% initiated ART during follow-up. Of 2672 tests for acquired drug resistance, 794 found resistance. The estimated 7-year risk (95% confidence interval) of acquired drug resistance was 3.2% (2.8,3.5) for immediate initiation, 3.1% (2.7,3.3) for initiation with CD4 cell count less than 500 cells/μl, and 2.8% (2.5,3.0) for initiation with CD4 cell count less than 350 cells/μl. In analyses restricted to individuals with baseline in 2005-2015, the corresponding estimates were 1.9% (1.8, 2.5), 1.9% (1.7, 2.4), and 1.8% (1.7, 2.2).

CONCLUSION:

Our findings suggest that the risk of acquired drug resistance is very low, especially in recent calendar periods, and that immediate ART initiation only slightly increases the risk. It is unlikely that drug resistance will jeopardize the proven benefits of immediate ART initiation.

PMID:
29135583
PMCID:
PMC5758415
[Available on 2019-01-28]
DOI:
10.1097/QAD.0000000000001692

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